“Mad Consumer Disease”: the response to BSE in the UK

Consumer response to the outbreak of Bovine Spongiform Encephalopathy has involved a complex balancing of risk and price

Bovine Spongiform Encephalopathy (BSE) has officially been recognised in the UK since 1986, a year after the first signs of disease amongst the UK herd. It was only in the 90s, though, that a link with the human illness, Creutzfeld-Jakob Disease (CJD) was investigated, leading to the famous announcement on 20 March 1996, by the health secretary in Parliament, that there was a ‘probable’ link between BSE in cattle and a new form of CJD, known as “new variant CJD”. This was the day that the floodgates opened. It has been described as Britain’s ‘most costly peace time catastrophe’, although that might have changed since the foot and mouth outbreak of 2001. I, fortunately, was working at the time as a dietitian in Health Promotion. My predecessor at the Meat and Livestock Commission, Amanda Wynne, was not so lucky.

Consumer reaction

That Government announcement precipitated an unprecedented response from both the media and consumers — the two obviously being inextricably linked. There was an immediate reduction in sales of some 30%, with consumers avoiding beef in its most obvious form, ie roasts and casseroles, but not meat products so much. This immediately gave a hint of consumers’ misunderstanding, as the incidence of BSE was much higher in dairy herds, from which meat products are more likely to be made, with prime cuts coming from beef cattle, which remained largely unaffected. There had also been a ban on the use of what are called ‘specified bovine offals’ since 1989, which included the spinal cord, thymus and brain, so it was likely that any possible transfer to humans occurred before this time. Stopping eating beef now was not really going to help.

At what price?

But what price are consumers willing to pay to reduce risk? Inevitably the price of beef plummeted shortly after the announcement in the Commons — one supermarket cut its prices by 50 %. The effect on consumers was dramatic — beef sales went through the roof! Some supermarkets saw a ten-fold increase in sales. There was suddenly a widespread acceptance of risk because it came at a bargain price. These are two examples of quotes that appeared in the press at the time: “There are still a lot of people who are buying beef and where it is reduced they are buying it in quite large quantities,” said a spokesman from Tesco. “I’m not all that confident, but it’s a good price and I’m willing to take the risk,” said one customer who bought half-price steaks. And well she might — the British Medical Association published figures at the time showing the risk of dying from CJD was 1 in 10 million (equal to being hit by lightning), compared to 1 in 8000 for a fatal road traffic accident or 1 in 200 for dying from smoking 10 cigarettes a day. I remember one person saying to me that they would buy the cheap beef and put it in the freezer until the scare was over!

There was clearly a point at which people were willing to trade perceived risk for cheaper food. It has been paralleled with the effect on the air industry following the September 11 disaster. In the month following, British Airways saw its passenger numbers to America fall by 32%. In contrast, the budget airlines have seen their trade boom. Admittedly, most of those airlines in the UK do not fly to America and you could argue terrorists are more likely to target the big carriers flying out of New York or Heathrow, than those flying to Tenerife from a minor UK airport like Luton or Stanstead. But people are remarkably consistent in the way they balance risk with price — consider your own behaviour regarding smoke alarms, bike helmets or your car tyres.

This has also been highlighted recently during the GE debate. Actually buying organic produce in a supermarket for example, does not always reflect reported behaviour.

Beef sales

Despite these quirks of human nature, beef consumption did drop overall during 1996, and it was hardly surprising that some people were anxious about eating beef when on a Friday the Government said it would give guidance on feeding children beef, but not until the following Monday! There was a considerable reduction in the consumption of beef from March 1996; this was not entirely due to a reduction in household consumption. Two hundred and three out of 204 local councils banned beef from their menus in March 1996, which most notably included schools, but also social services. Interestingly, a similar reaction has been seen in France in 2000, after a confirmed case of vCJD (though not their first), with beef being taken off all school menus and beef sales falling by 20-50%.

The response since

Since 1996, consumer confidence in British beef has increased dramatically. Continuing with the analogy of the air industry, it is said to be safest to fly the day after a plane crash — I think that is true in NZ too. Britain has had to examine its procedures in tremendous detail, and consumers are recognising the changes that have been made, and are keen to buy a product in which they now have confidence. Beef sales are not only back up, but exceeding pre-BSE levels. A Mori poll in 1999, of perceived “threats to health”, showed the fear of BSE at the bottom of the list, well below the major killers of cancer and heart disease.

Having been one of the first fast food chains that stopped using British beef in 1996, McDonalds threw its weight behind an industry initiative in 1998, aiming to increase consumption of the British product. Following the launch of this “Buy British” campaign, two thirds of those surveyed preferred to buy meat produced in the UK, 40 % ranking it “very important”.

But in October 1998, 170 local authority bans still remained in place. This triggered a high-profile campaign by the industry, enlisting the support of Government, the Food Standards Agency and a well-respected scientist, Hugh Pennington. This was required to counter the “well, you would tell us it’s safe, wouldn’t you” sort of reaction. Within a month, 56 local authorities had lifted their bans, and within six months only three remained. Today, just two bans remain, plus a couple in primary schools. The key issue in terms of returning to beef was traceability, even outweighing price — though only just. Consumers needed reassurance, focused on identified consumer concerns. Several quality assurance schemes were introduced throughout the food chain, most notably one for mince, introduced quite soon after the crisis began. It was a rosette developed for use on mince, stating that the product did not contain offal, and was made from cattle less than 30 months of age. Consumers had become concerned about the quality of mince, and this quality mark worked well to reassure them. It was later extended to burgers as well. Consumers in the UK are as responsive to stickers on packs as they are here. Even if they don’t fully understand what they mean, it is a symbol of quality. Food safety is still a major concern for consumers in the UK — highlighted by the latest consumer attitudes survey, carried out by the Food Standards Agency — but it is broader than just BSE. Unsurprisingly, food poisoning is of greatest concern in Scotland, reflecting the site of the E. coli outbreak, also in 1996, in which 20 elderly people died. But over 90 per cent of those surveyed eat meat on a regular basis, with true vegetarianism still below 5% of the population.

Reaction in NZ?

So how did consumers react here at home? It appears to have been perceived very much as an overseas problem, and if anything helped our product. The fact that NZ is BSE-free reinforced consumers’ confidence in the NZ product and the meat production systems employed here, ie grass-based and extensive. What of the farmers?

In conclusion, I would ask you to spare a thought for the farmers. By March 2001 there had been 95 cases of vCJD in Britain. And whilst no one would deny it is a hideous illness, compare this to the number of suicides amongst farmers and the figures pale dramatically. In 1999, there was more than one suicide a week amongst farmers, totalling 400 over the last few years. This, as far as I know, never made the headlines.

Acknowledgements

Grateful thanks go to former colleagues at the Meat and Livestock Commission for supplying information for this paper, in particular Chris Lamb, consumer marketing manager and Tony Goodger, trade sector manager.

This article is reprinted with permission from the Proceedings of the Nutrition Society of New Zealand 27, 97-99.

Back From the Dead?

I’ve just witnessed a miracle. Probably. On January 2 I took part in a trip to the outer Hauraki Gulf to search for a bird that until recently had not been seen since the nineteenth century. Three specimens of the bird, the New Zealand Storm Petrel, sitting in museums in Paris and London, were believed to be the only representatives of yet another of this country’s extinct species.

Then in January 2003 a bird matching the New Zealand Storm Petrel’s description was photographed off Whitianga. By itself that didn’t mean too much; sometimes you get strange individuals of common species, and this bird’s resemblance to the lost petrel may have been coincidence. But in November two British birdwatchers saw 10 or 20 birds just north of Little Barrier Island that looked just the same, and took some amazing photos (http://www.wrybill-tours.com/idproblems/stormpet3.htm). And our trip found at least three in the same area. Needless to say, we were over the moon. Here’s one of our pictures; not as good as the ones on the website, but clearly it’s the same thing.



So can a species really go more than a century without being recorded, less than 100km from Auckland? That’s what we skeptics would call an extraordinary claim, and quite correctly the Ornithological Society’s Rare Birds Committee isn’t rushing to confirm the bird’s continued existence.

But with every week that goes by, the case is looking stronger. Trips are now going out regularly, and amassing considerable documentary evidence. In the latest development, TV3 News has shown film of the bird. It’s all developing in a way that’s very different from sightings of moa, lake monsters, or Bigfoot, which are invariably isolated events with no follow-up. There’s definitely a bird out there in the outer gulf that wasn’t there before (at least not in any numbers), it looks just like the museum specimens, and not really like any other known species.

Possibly it’s an unexpected dividend of the rat eradication programme on our offshore islands; maybe a tiny population was able to hang on until the rats were gone, and they’ve bred up in the intervening years to the point where people are starting to see them.

Whatever the explanation, it looks like the biggest thing to happen in New Zealand ornithology since David Crockett rediscovered the Chatham Island Taiko in 1978, a mere 111 years after its last sighting. And it’s a reminder that however much we think we know about the world around us, nature can still spring surprises.

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Another Year goes By…

Vicki Hyde presents the Chair-entity’s report for 2003

It’s been another busy year, mostly working behind the scenes, with the occasional burst into the public arena.

For the second year running, we celebrated Darwin Day, with a birthday cake and Darwin Day lecture in Christchurch. It would be great to see other areas join in to put February 12 on the calendar as a day to celebrate science and humanity. Anyone interested in doing this should contact me for Darwin Day support material and ideas.

The Darwin Day Collection Volume One was published in the US, with a selection of articles from New Zealand skeptics sitting alongside material from the likes of Richard Dawkins, Steven Pinker and assorted stellar luminaries. There are plans to put a collection out every couple of years as part of the international Darwin Day activities. Copies are still available from the secretary.

Following on from the discussion at last year’s AGM, we ran a Teaching Critical Thinking Competition, offering a $1000 prize for a one-page teaching resource that could be used by teachers and parents. The competition announcements were picked up by a wide range of educational publications and passed on through email groups; we also thank Jonathan Harper who kindly included posters within a mailout he was sending to schools.

Around 30 entries came in from round the country, with the winning entry dealing with assessing the evidence for the existence of the moa. We are using the entries to develop a kit which we hope to distribute to schools as part of the second competition’s promotional activities, and have applied for NZ Post Community Post support to help with that.

The 2002 AGM proposed that “NZSCICOP petition the House of Representatives for the estab-lishment of a Royal Commission of Inquiry into the Civic Crèche Case and the judicial and forensic counselling issues arising therefrom.” Moves to do so had got under way when we were contacted regarding what has been termed the “VIPs’ petition”. The suggestion was that Parliament would find it more difficult to ignore a petition coming from those perceived to be influential members of the community. The committee agreed to put their support behind this initiative, and I signed the VIPs’ petition as Chair of NZCSICOP. We also provided information on the petition and its later expansion, via the website and email alert list.

The petition is very similar to the motion as passed at the 2002 AGM:

“We the undersigned petition the House of Representatives to urge the Government to establish a Royal Commission of Inquiry, presided over by a Judge or Judges from outside the New Zealand jurisdiction, to enquire into all aspects of the investigation and legal processes relating to the Christchurch Civic Crèche case. This case is one of great public and professional concern, and raises serious questions about the administration of justice and the working of existing laws, which must be addressed.”

Media contacts continued throughout the year, with requests for television appearances, expert advice and commentary. Among the contacts were Isola Productions, NZ Radio Training School, Bay of Plenty News, Plains FM, Newstalk ZB, and Next magazine. UFOs were a big thing at one stage, with no fewer than four independent contacts in the space of two months.

The National Radio Sunday Supplement provided a useful slot to publicise our concerns. At the beginning of the year I covered problems with homeopathic “vaccines” being sold in Auckland and, interestingly, made contact with the president of the NZ Homeopathic Society, who was equally concerned. Should these vaccines rear their heads again, we’ve agreed to issue a joint release condemning the practice! Another Sunday Supplement concerned the topical issue of the Pan Pharmaceuticals recall, which dealt an all-too-brief blow to the credibility of the supplement industry.

We had a very intense flurry of activity when discovering by accident that the Ministerial Advisory Committee on Complementary and Alternative Health had apparently called for submissions on introducing, regulating and integrating CAM care in New Zealand. Despite contacting them fairly regularly over the past couple of years, we hadn’t made it on to their notification list…. With four days to the deadline, we managed to pull together comments and material from researchers worldwide to produce a 30-page submission, and made this available for viewing online.

The website and email alert list continued to be useful in getting information out to members, the media and the general public. As well as the CAM section, we added sections on the Christchurch Civic Crèche petition, magnet therapy, and more information flyers for downloading and printing with more in the pipeline. There is a proposal to provide full sets of the flyers to members for local distribution, and this was discussed at the AGM.

Bravo Awards were distributed as nominations came in, and have been made to Alan Pickmere for sterling work regarding alternative medicine claims in Northland; and Barry Colman for putting his money on the line with his publication of transcripts from the Christchurch Civic Crèche case. I’d encourage you all to keep an eye out for people who deserve a pat on the back as it is good to be able to be positive and, importantly, be seen to be positive.

I’d like to conclude by expressing my strong thanks to Joanna Wojnar, who almost single-handedly pulled the conference together by being our person on the ground. She’s a great example of how one person can make a significant contribution.

All the best,

Vicki Hyde
Chair-entity

Living in Interesting Times

Had an email the other day from someone we hadn’t heard from in a while. Among other things, he took the opportunity to ask why we heard so little from the Skeptics in the media, and made unfavourable comparisons with the Consumer’s Institute. Given the breadth of that organisation’s support base and consequent level of funding, that hardly seemed fair.

I guess the media have a lot of calls on their attention, and a rational voice often seems to be the last thing they want to hear. But there has been a lot of often unrecognised activity from individual members, and this is reflected in the makeup of this issue. Bill Keir, for example, has been investigating claims about New Zealand prehistory. By an amazing coincidence (how do Skeptics explain this kind of thing?) our email correspondent also wanted to know why the society wasn’t challenging the conventional archaeological paradigm when there was so much evidence that the Phoenicians, Egyptians, Romans and others had colonised this country at least 2000 years ago. Bill’s article had arrived a couple of days previously and it was very nice having it on hand to refute a couple of points straight away.

In a similar vein, Alastair Brickell reports on the evolving (if that is the appropriate word) situation with the most active of the New Zealand creationist groups, Answers in Genesis. And several society members were signatories to the widely publicised Peter Ellis petition.

Bob Brockie is just one of several columnists and journalists in the society. We republish one of his columns from the Dominion Post in this issue; look for more in the future. Of primary concern to the society has been the Complementary and Alternative Medicine (CAM) discussion document, also reported in this issue. Again, individual members have sent in submissions alongside the official one from the society.

Then, of course, there’s the annual conference which is once again upon us. This is always an enjoyable event, and once again the organisers have come up with a first-rate lineup of speakers. Hope to see as many of you as possible in September.

Finally, thanks to all of you who alerted us to the absence of apostrophes and other punctuational oddities in the last issue. The gremlins responsible have been rounded up and disposed of humanely.

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Hokum Locum

Diffidence based medicine

Some doctors see a problem and look for an answer. Others merely see a problem. The diffident doctor may do nothing from sense of despair. This, of course, may be better than doing something merely because it hurts the doctor’s pride to do nothing.
New Zealand Medical Journal Vol 113 No 1122 p479

Maori Traditional health (Rongoa Maori)

I have received a letter dated Sep 30 2002 answering some questions I had asked on this matter. $1,190,000 has been allocated nationwide to 12 contracted Rongoa Maori Providers. The Marlborough share amounts to $100,000. This seemed to me a golden opportunity to have Rongoa Maori evaluated by the Ministerial Advisory Committee on Alternative Health (MACAH) but the letter tells me “The Rongoa Traditional Healing services will not be referred for evaluation by the MACAH at this time as it does not fall within their terms of reference”.

It seems to me that MACAH has become a redundant quango, much like the similar body in the US (National Institute of Health) which has also failed to make any meaningful comments on the efficacy or otherwise of any alternative medical modality. It would of course be disrespectful to Maori to test Rongoa medicine and show that it was useless.
Letter from Deputy Director-General, Maori Health, dated 30 Sep 2002.

Nuclear Test Veterans

When people believe that their health has suffered from some experience they can become obsessional and develop all sorts of strategies for defending their delusional beliefs. A British study found that veterans of nuclear tests were no more susceptible to cancers than members of the public. Sound familiar? Just think about Gulf War Syndrome and the current fuss over the spraying of the painted apple moth in Auckland.

A spokesman for the veterans was quoted as saying that the findings would not affect the push for compensation. I have seen claims from these people that as various tests were conducted they could see an Xray of their hand bones during the flash! This is fantasy and the whole thrust of the compensation issue is the belief that they were used as “guinea pigs”. There has never been any evidence that servicemen were deliberately exposed to radiation as an experiment.
Dominion Post 26/2/03

Sudden Infant Death Syndrome (Sids), Murder and logic

After a family had suffered four deaths from Sids, a woman’s estranged husband found her diary in which she documented how she had actually murdered the children. Post-mortem examinations at the time were inconclusive (Marlborough Express 2/4/03).

This case reminded me of another similar episode where a plausible woman murdered five children and was written up by a gullible paediatrician as a case of “familial Sids”, despite the protestations of an experienced pathologist who is quoted as saying: “One unexplained infant death in a family is Sids. Two is very suspicious. Three is homicide”. There is a book about this case and in my opinion it is essential reading for all Skeptics because it has so many lessons about belief, logic, flawed research and delusional thinking.
The Death of Innocents by Richard Firstman & Jamie Talan, Bantam Books

Severe Acute Respiratory Syndrome(Sars)

The media have been doing their usual excellent job of fostering panic and hysteria over a viral illness that has a mortality rate of only about 3 per cent and kills mainly old sick people. The reporting has been abysmal with no attempt to compare Sars with, say, influenza, and no intelligent discussion about mortality rates as compared to other common infectious illnesses. In my hometown of Picton there has been a run on facemasks and pharmacies are having to restock. After about 15 minutes of use facemasks become useless.

I have heard only one commentator reminding us that millions of people die every year from tuberculosis, malaria and Aids.

Variations on a Theme

When a placebo therapy becomes commonplace, it can be a good marketing tool to introduce some subtle variation which adds novelty and appeal. Chiropractic is a placebo therapy based on a plausible but unproven theory and using the power of touch (laying on of hands). The “McTimoney is a more gentle form of chiropractic involving small fast movements to release key muscles, allowing the bones to naturally move back into place”. A new local practitioner is quoted as saying “It’s very exciting. I feel a bit like a missionary”.This is quite an appropriate metaphor because many alternative practitioners have an air of religious fervour and this type of personality enhances the placebo effect.

These subtle variations of alternative medicine are unlimited and it makes good sense to use them in combination. This maximises the placebo effect.
Marlborough Express 9/4/03

Ambrotose

Placebos are sometimes referred to as “sugar pills”.It is rather fitting that Ambrotose is made from eight sugars, aloe vera and vegetable extracts. A month’s supply costs $300 so the profit margin must be huge. It appears that New Zealand has a vast population of gullible consumers with too much money. As WC Fields said: “Never give a sucker an even break”.

I have thought of a product for such people:

“Gullitose” is made from only natural sugars and salts. It is a health supplement (insert here 20 fictitious testimonials from cripples, mother of six and Aids victims) and assists the natural healing of the body. Send $400 to (insert PO Box number). Discovered by Professor Leiw PhD (University of Wakula Springs) (insert picture of jovial bearded man).

All joking aside, it is sad to think that people are wasting their money on sugar pills. $300 is a week’s wages for many people.
Dominion Post 12/3/03

Forum

Alternative Child Healthcare

The following correspondence between nursing lecturer Sue Gasquoine and Skeptics’ chairentity Vicki Hyde is reproduced with the permission of the participants -ed.

Hello Vicki,

I heard you talking to Wayne Mowat on National Radio yesterday. I have a theory for you to consider as you wonder why New Zealanders view with such skepticism “religious” reasons for denying children treatment (epitomised by the death of baby Caleb Moorhead) when there seemed to be significant support for Liam Williams-Holloway’s parents when they decided to “hide” him and seek “alternative” therapy.

There is a world of difference between diagnosis with and death from a vitamin deficiency and diagnosis with and death from cancer.

Vitamin deficiency is entirely avoidable even with very strict diets. Cancer in children is not. Treatment of vitamin deficiency is generally uncomplicated, entirely successful and has few side effects. Treatments for cancers such as radiotherapy and chemotherapy are by no means uncomplicated and are often associated with distressing side effects. They vary in their effectiveness depending on the type and location of the cancer and are by no means a guarantee that the child will survive.

There are few if any useful parallels that can be drawn between parents trying to act in the best interests of their child with cancer, who may in the process decline treatments offered by western medicine and parents who do not recognise the ‘necessaries of life’.

I think New Zealanders recognise this critical difference which has been absent in most media coverage of these tragic events. They do well to be skeptical of religious fanaticism, alternative therapy AND western medicine which also makes false claims – the “safety” of HRT and the rate of caesarian births being the most recent examples!

Sue Gasquoine, Lecturer – Nursing
School of Health Science, Unitech

Vicki responded with:

Thanks for the feedback — always appreciated.

I certainly agree there is a world of difference between diagnosis with and death from a vitamin deficiency and diagnosis with and death from cancer, and it may well have been a contributing factor though not, I would suggest, a major distinction made by people in looking at the various cases.

I say that because of the Tovia case just before Liam’s one, which also involved refusal of cancer treatment for a child (albeit a 14-year-old), but this time on religious grounds.

In that case, there was, as with the Moreheads, a much more critical view taken of the parents and their role in refusing treatement. They were also taken to court, at one stage facing manslaughter charges, and were generally condemned in the media.

I have had many discussions with legal, media and medical people about the differences between this case and that of Liam Williams-Holloway, and the treatment the two families got in the press and in the court of public opinion.

I think that it would be possible to argue that Peni and Faafetai Laufau, the parents of Tovia, deserved a more sympathetic treatment in some respects because (1) they were doing it on sincere religious beliefs, not based on a book which touts conspiracy theories and coffee enemas as cancer treatments and (2) their son was of an age to arguably be a part of the informed consent process, and expressed his own wish to refuse treatment.

Much in all as I hate to say it, the main points of difference can be attributed to a couple of factors I suspect — the Laufaus were Pacific Islanders, of lower socio-economic status, and religious. Treena and Brendan were white, middle-class, articulate and constantly described as making a “well-informed choice”.

It’s a most uncomfortable set of differences in its implications…

I do think that there is culpability in both the cases you cite and in that of the Laufaus. There is a great deal regarding the Liam Williams-Holloway case which was not adequately addressed by the media, and I can understand why those involved continue to feel a certain amount of despair and anger at what happened. (I’d be happy to discuss this further if you like, or if you have any questions about it.)

And you are so right that it is vital we cast a critical eye over any claims in all areas. What we have to do is to ensure that we have some way of helping us determine what claims there are, what the level of evidence is to support those claims, and what the risks are in accepting or rejecting that evidence.

All the best,
Vicki Hyde

B.Sc.(Astrol.) anyone?

Ever felt queasy about the courses the New Zealand Qualifications Authority gives its approval to? Remember the fuss over the Indian government’s encouragement of university courses in astrology? The infection is spreading; some well-known British universities are also up to some curious activities. A recent correspondent to the science journal “Nature” reports on a charity called The Sophia Project, which has money to give away for work that sets out to establish that astrology is a genuine science. Four institutions are named as having accepted funds for this. Studies include: planetary influences on fertility and childbirth, and on alcoholics, and looking for correlations between birthdate and prostitution.

The correspondent is concerned that, despite the private funds provided, some taxpayers’ money is inevitably going to support this “bogus research”. Of perhaps greater concern is that these universities are giving undeserved respectability to this nonsense.

Bernard Howard

A Letter from the Skeptical Left

I admire your work against creationism, but I have to ask why it is that proponents of lesbian and gay rights and reproductive choice on abortion have to fight junk science from the Christian Right on our own.

I am concerned that you appear to have swallowed petrochemical industry propaganda against the Kyoto Treaty, surely akin to the tobacco industry’s pro-smoking agenda in motive, intent and overall poor empirical rigour. As well as that, there is a wide-ranging debate over questions of “false” and “recovered” memories within the mental health professions, yet your organisation seems to be listening to the male backlash lobby, quite capable of its own imaginary junk science when it comes to its own control freak agenda against victims of family violence.

Craig Young, Palmerston North

…And one from the Skeptical Greens

When I read Professor Dutton’s vitriolic attack on the Greens in the Weekend Herald of September 28/29, I immediately thought he must have been inspired by the frantic ravings of another American whom we’ve heard quite a bit from lately. However, to give Professor Dutton his due, he did stop short of suggesting we should wage a war of attrition upon Green subversives.

His passionate defence of science reminded me of the attitude adopted by devout religionists over the centuries. Professor Dutton accuses environmentalists of a similarly distorted mindset, but despite the fact that all movements have extremist factions, he is well off track with his generalisations, if for no other reason than that the Greens are concerned for the well-being of things that actually exist, and have been carefully examined. Religionists on the other hand operate for the most part on pure supposition.

Science is not a religion. However it would seem that there are several people involved in that noble art who regard it as such. That is indeed sad, and a reprehensible distortion of mankind’s only reliable method of inquiry into most subjects. The scientific method should be an intelligently used force that will tell us often bumbling humans how far in any direction we should attempt to go. Unfortunately, the caution factor is all but ignored these days in favour of the hedonistic delight of having found something new that works. Apart from the financial and economic benefits, the other outcomes of a new discovery are often made less transparent, until of course, somewhere down the track something highlights a hidden disaster factor that was not thought worthy of mention at the time of the discovery’s introduction.

My final word to Professor Dutton is that he should place the blame for the world’s starving millions exactly where it belongs. Greedy corporate giants, environmental exploiters, warmongers, and corrupt officials will do for a start. Compared with that lot, we greenies aren’t even in the picture. (Abridged)

Peter E Hansen, Auckland

Faith Healing Documentary Rapped with 2001 Bent Spoon

A documentary on faith healing that promised to scrutinise the practice demonstrated short-sightedness and has won for TopShelf Productions the 2001 Bent Spoon Award from the New Zealand Skeptics.

“We had lots of nominations for the Bent Spoon this year, but it came down to two programmes on TVNZ’s Documentary New Zealand slot, one on hauntings and one on healings. We realise that documentary makers these days are more concerned with entertaining than educating, but when they show vulnerable people being exploited spiritually, physically or economically, we think that they should do more to examine critically what’s going on,” says Skeptics Chair-entity Vicki Hyde.

The Skeptics point to common psychological effects at work, ranging from taking advantage of a strong pre-existing belief or desire for a response through to the pressure people are put under to comply with a group. Such practices have been used by everyone from the Nazi Party to stage hypnotists, and even play a role in people’s responses to conventional medical treatment.

“When you have someone talk about having the living daylights scared out of her by a faith-healer, it’s little wonder she was willing to follow his insistent commands that she walk despite her arthritic pain. Fortunately for her, it didn’t lead to any damage. When you get people talking about casting out demonic spirits, that’s when you really

have to start worrying because it can lead to deaths, as we saw in Auckland earlier this year.”

“Hallelujah Healing” said it would test such practices, but the people it concentrated on were ones who already had an involvement with prayer groups and healing sessions. It did not offer any alternative explanations, nor did it speak to any medical or psychological experts. Any faint questions it raised were overwhelmed by the very strong ‘witnessing’ by the members of such groups and by the supreme confidence of the healers themselves, say the Skeptics.

“We demand strong evidence from our medical fraternity when they want to muck around with our bodies and our minds. We should demand equally strong evidence before we let anyone else do the same.”

The quest for evidence was a feature of those winning Bravo Awards from the Skeptics this year.

“We know our documentary makers can produce well-researched thoughtful programmes, like Rob Harley’s ‘Desperate Remedies’ on Assignment last October, which looked at what drives people to seek alternative cures. It’s great to be able to acknowledge that sort of quality.”

Also acknowledged in the 2001 Bravo Awards are:

  • Susan Woods for asking the right sort of questions regarding possible evidence for the Fiordland moose, Holmes, 27 June 2001
  • Professor T W Walker, for his gardening column in the Christchurch Press which often addresses the “muck and magic” issues of various gardening approaches
  • Denise Tutaki, for her item “Calling 0900 Psychic… Okay, now tell me something I don’t know”, Horowhenua-Kapiti Chronicle Feb 28, 2001
  • Dr Pippa MacKay, for her commentaries on medical issues, particularly bogus cancer remedies

The awards will be officially announced at the Skeptics’ conference at Hamilton’s Waikato Diocesan School for Girls (September 21-23). The Bent Spoon Award is named in honour of Uri Geller, the former nightclub magician who claims he can bend metal with his bare mind. The Skeptics have their doubts.

Belief in the Paranormal on the Increase among Americans

The Gallup Organization released the results of its new poll on paranormal beliefs in June, which indicate increases in the percentage of Americans who believe in communication with the dead, ESP, ghosts, psychic healing and extraterrestrial visitation (see http://www.gallup.com/poll/releases/pr010608.asp).

“This latest Gallup Poll is disturbing”, says Paul Kurtz, chairman of The Committee for the Scientific Investigation of Claims of the Paranormal (CSICOP), “because it shows an increase in superstition in the US – particularly in regard to communicating with the dead, haunted houses, ghosts, and psychic healing.”

According to the study, the most notable increases between 1990 and 2001 are beliefs in psychic or spiritual healing (up eight per cent to 54 percent); haunted houses (up 13 per cent to 42 per cent); communication with the dead (up 10 per cent to 28 per cent); and witches (up 12 per cent to 26 per cent).

Kurtz blames the media for increased credulity. “These results may be traced directly to the mass media, especially sensationalized TV shows, films, and the tabloid press and publishers. It’s regrettable that Americans show lower scores in scientific literacy among their young people in comparison with other democratic societies. The poll also points to the urgent need, we submit, for teaching critical thinking in schools and colleges. That should have a high national priority.” The National Science Board’s 2000 Science & Engineering Indicators survey found an abysmally low understanding of the scientific method and general science knowledge among Americans (see http://www.nsf.gov/sbe/srs/seind00/frames.htm).

CSICOP Senior Research Fellow Joe Nickell feels that the poll asks the wrong questions. “The poll asks people whether they believe in a phenomenon, which amounts to asking them whether they want to believe. They’re polling the heart, not the head. If respondents had also been asked whether they have experienced these phenomena themselves, or whether they thought there was good scientific evidence supporting these beliefs, I suspect those scores would have been much lower.”

CSICOP Press Release

My Life of Hell – Sub-editor Tells All

My brain hurts. I haven’t used it in some years, so there’s no surprise really. After managing to avoid external employment for a goodly time, a job has finally got its teeth into me and won’t let go. Which is not to say I’ve been totally lazy at home these past years, there’s been free-lunch work to do and projects such as the NZ Skeptic to help pass time. But all of these could be done in the privacy of one’s own home, dressed in striped jarmies if the mood took and it often did.

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Raising a Skeptical Family

Being a skeptical parent in New Zealand isn’t always easy, but it has its rewards. This was originally presented to the Skeptics’ World Convention in Sydney, in November.

When I became head of the New Zealand Skeptics seven years ago, the irrepressible Denis Dutton had great delight in ringing the major newspapers to announce the fact that the organisation had elected someone who was female, of Maori descent and pregnant.

“How more politically correct can you get?” he crowed triumphantly. I don’t know about elsewhere around the world, but for some reason the New Zealand Skeptics are rarely seen as PC.

What Denis didn’t know was that the gravid situation provided me with a great excuse to pass back to him the many invitations to speak to seemingly innumerable numbers of Rotarians, Roundtablers, Lions, Great Elks and other assorted male mammalian service groups. There’s nothing surer than saying you’re pregnant to get an all-male group to back off hurriedly.

I like to think of it as part of my personal crusade to singlehandedly boost the skeptical population of our country.

I must say that people seem to delight in predicting that my sons are going to grow up to be Sensitive New Age Guys. If they really want to make me nervous they add that David and Perry will be New Age, rugby-playing accountants who’ll end up working for Treasury. I can’t see it somehow – after all, they’re both fire signs…though I do find it a bit worrying that my seven-year-old has started paying attention to the stockmarket reports and cheering every time Telecom drops a few more points.

Of course, his interest-and incidentally the reason why the bulk of this audience is male-is explicable. According to psychologist Bertrand Cramer, it all relates to early adolescent experimentation with gender-specific body parts. Most notably that manipulation which causes said body parts to move and retract, which, according to Cramer:

“…presents the boy with a particular challenge in the development of the body image; this may contribute to his interest in machinery, physics and the like.

“The boy’s better spatial sense relates to the greater use he makes of space in motor activity; the ability the boy has to perceive his sexual organ may also contribute to a better representation of space and to his better skill and greater interest in experimental science and mathematics.”

One can only conclude from this that women should be over-represented as mining engineers, tunnellers and speleologists….

Anatomy and Skepticism

I must confess to a certain degree of scepticism concerning the relationship between gross, so-to-speak, anatomy and an interest in science or its handmaiden, skepticism.

I attribute my interest in skepticism to my early fascination with science and science fiction, thanks to writers such as Arthur C Clarke and Isaac Asimov. In both their fiction and non-fiction, they posed questions and looked for answers, they acknowledged the sometimes-tentative nature of their conclusions, they changed their minds when the facts built up against them. Their science was not the boring stuff of school textbooks, but involved real people trying to find answers to all manner of questions.

They raised real concerns about where the world was heading long before anyone had started worrying about the H-bomb or the China Syndrome, Dolly the cloned sheep, or global warming.

Of course, by no means have all their predictions of the future been accurate ones; nor have the predictions made from respected scientists or the even more highly respected astrologers. Arthur C Clarke knew this when he postulated his First Law which states that:

…when a distinguished but elderly scientist states that something is possible, he is almost certainly right. When he states that something is impossible, he is very probably wrong.

There are times when this Law is overthrown, as noted in Isaac Asimov’s Corollary to Clarke’s First Law:

…when the lay public rallies round an idea that is denounced by distinguished but elderly scientists, and supports that idea with great fervour and emotion, the distinguished but elderly scientists are then, after all, right.

And while I read Asimov and Clarke and Sagan and Feynman, I was also reading Velikovsky and von Daniken. I tried experiments with Rhine Cards and fervently scanned the skies hoping for a close encounter of my very own. I drew up natal horoscopes in my astrophysics labs, and made more money off astrological charts than I ever did from writing astronomy columns.

But throughout it all, my tendency to ask questions, to try and look at all sides of an issue, stuck with me. That was helped by a goodly dose of debating at school and university level, probably one reason why I tend to be an equivocator.

And, if I want to get Freudian, I can blame my father. He was a staunch non-believer in gravity, and we had lots of arguments about air pressure, centrifugal forces, Newton and apples. I’m still not sure to this day whether he was having me on or not, but it taught me never to accept things at face value.

A Conundrum

The latter is something we could all do well to remember. I think the most stunning example of this I’ve seen came from a speaker we had after our annual skeptics dinner one year. We’d settled back in our chairs and were presented with the following conundrum:

Two men – James and John – are in a room. James is taller than John. John is taller than James.

How do you explain that? Just think about it for a moment. James is taller than John. John is taller than James.

Well, we had a room of 100 or so skeptics, the most critical minds in the country, and the suggested explanations were legion, not to mention ingenious. I’m sure many of you have already thought of similar solutions to the ones we came up with:

James is standing on a box but John is actually taller.

The floor slopes.

James was taller but then some time passed and John grew taller than James.

The gravitational field is different in different parts of the room.

By the time we started to argue about the effect of singularities, the speaker called a halt and put us out of our misery. There were two obvious explanations that we had failed to come up with:

He was lying OR he was mistaken.

We’re just not taught to be suspicious enough. As a species, we’re suckers for the confident conman. It’s laughable when it’s some guy with a toy submarine drumming up some tourism in a local loch; it’s not so funny when we’re asked to believe that another part of the human race is inferior based on their skin colouring or religion.

I find it sad that few people bother to ask questions. It’s an indictment really of how little critical thought enters our lives, how rarely people are prepared to think, really think, about issues that may affect them. This holds as true for any activity in which we participate, whether it’s debates on astronomy and astrology, alternative medicines and health reforms, or the way in which we choose our political representatives.

I remain highly skeptical about acupuncture and its uses, but didn’t really start to question it until a mother in my local baby group announced that her acupuncturist had said the best way to treat a baby with a fever was to bleed it. “That’s positively medieval” I gasped, only to be reassured “oh no, it’s much older than that, it’s Chinese.”

I knew this woman wasn’t going to be interested in a tirade, but I pointed out just how little blood a small baby has to lose before it gets into dire trouble. She could see what I was getting at. But maybe only because I was the closest pseudo-authority figure at the time.

Healthy, Natural Diseases

Some of these women refuse to have their toddlers immunised because it’s not natural. Somehow it’s more healthy for their children to get diseases – they’ve had measles, mumps and whooping cough so far. These are women who worry about radiation from their microwaves and electric blankets, but who drive their kids around in their urban combat vehicles without safety belts. These are women who listen to the health shop staff and buy heaps of herbs, royal jelly and megavitamins, but who automatically distrust anything to do with Western conventional medicine.

You can’t argue with them, that’s confrontational. Yet you can’t leave them to their wilful ignorance unless you’re willing to accept that the price of the New Age is an uninformed populace making decisions based on supposition and superstition.

And why worry about some ditzy women? Well, it’s said that if you educate a man, you educate an individual. If you educate a woman, you educate an entire family.

I believe that we each have a responsibility as individuals, as parents, as citizens to be educated – that doesn’t mean sending everyone off to university. What it means is having enough nous to ask questions until we can understand or, perhaps more importantly, can recognise our lack of understanding. It also requires us – whether operating as card-carrying members of the Skeptics, or simply as friends and parents – to encourage questions, to provide alternative viewpoints, to make our case effectively.

If you explain homeopathic solutions in terms of a teaspoonful of gin stirred into a Pacific Ocean of tonic, people can immediately grasp what you’re getting at when you challenge the idea of potent dilutions. Start talking in terms of moles, millifibles or inverse powers of ten and you’ve lost them.

The New Zealand Skeptics had toyed with killing two birds with one stone by taking on the homeopaths and the urine-quaffers simultaneously – we figured we’d take a glass of urine, dilute it homeopathically way past any chance of a single molecule of urine remaining and invite the press along to see the “Skeptics Take the Piss out of Homeopathy”. We weren’t confident we could explain the maths to the representatives of the Fourth Estate however.

If you encourage people to stop and think about it, they know that it doesn’t seem all that likely that a civilisation immeasurably more advanced than ours would want to travel millions of miles across space to stick things up the noses of neurotic Americans. The idea becomes even more ridiculous when you point out that the figures being bandied about for alien abductions mean that one American has been abducted every minute every night for the past 30 years. People know that there are simpler solutions. Even children can figure that out.

Effective Presentation Essential

We do need to present our case effectively, because if we don’t, the fallout can be disastrous. It’s easy to laugh at tales of UFO abductions – it’s not easy to laugh at a child’s coffin. We’ve had a huge debate in New Zealand over the past 18 months as to the rights of the parent to decide what is appropriate treatment for their children.

Many people would argue that parents have the ultimate right and responsibility. I can decide what is best for my child. After all, I’m a caring, well-educated, white middle-class parent who dearly loves her children and would do only what is best for them.

Sounds reasonable you say? But be careful. After all, I may truly believe that it is appropriate to beat my child. People do. I may think it appropriate to withhold a life-saving blood transfusion from them. Jehovah Witness parents believe this sincerely. Or I may decide that my child will be better off having quantum-boosted radio waves or happy thoughts beamed at his cancerous growth, rather than nasty chemotherapy. After all, in commenting on just such a case, the New Zealand Health and Disability Commissioner said that parents have the right to choose what treatment is given to their child.

I do wonder if the commissioner would uphold the rights of people who believe their child’s diabetes will be aided by prayer, rather than by insulin. Somehow I doubt it. After all, in one recent case, two parents were charged with manslaughter for withdrawing their 13-year-old son from chemotherapy treatment for a 15-kilogram tumour – the prayers hadn’t worked and the boy died.

Yet, in the cause celebre that was the short eventful life of Liam Williams-Holloway, it appeared that something was different. There are a number of factors that one could point to: the parents were white and middle-class, not Samoan and poor; they gained supportive media coverage from our major news celebrity Paul Holmes; and they were relying on alternative therapy, which sounds more effective and reasonable to a secular society than appealing to God.

Liam had neuroblastoma cancer, with a tumour on his jaw. It’s a difficult cancer, but when the oncologists first saw him when he was three, they thought he had a 60-70% chance of beating it if they could treat it quickly. This type of cancer has a very fast drop-off in success rate; by the time children with it reach five, they have about 15-20% chance of survival.

Chemo Courses Stopped

Liam had had two courses of chemo and then stopped. The oncologists made numerous attempts to talk his parents into bringing him back, including agreeing to alternative treatments running alongside the conventional, to no avail. Healthcare Otago eventually went to the Family Court and Liam was made a ward of the courts to enforce treatment; it’s not an uncommon outcome in this sort of case, though is more typically used to permit blood transfusion for Jehovah Witnesses’ children.

At that point, things careered out of control. The family went into hiding so they could pursue alternative treatment, in this case Rife Quantum Frequency therapy which promised to explode all the cancer bacteria in Liam’s jaw. The Holmes prime-time current affairs program portrayed them as a loving, well-intentioned family hounded into hiding by uncaring oncologists for having the temerity to question orthodox medicine. The country was up in arms about the perceived jackboot tactics of the medical profession; talk-back phonelines ran hot; the police copped it in the neck for being a party to the search for the child; the Family Court made the unhelpful decision to try to muzzle any media reports on the case.

One constant refrain throughout was that the decision to stop chemotherapy was an informed one. I was therefore dismayed to see the family citing the book “Suppressed Inventions and other Discoveries”, as a reference source; a book initially published, I am sad to say, by our own Auckland Institute of Technology.

As its name suggests, this book deals with a vast range of conspiracy theories, from NASA’s suppression of evidence for intelligent life on Mars through to the perpetual fruitless quest for free energy sources. It is the stuff of which fortunes are made by those prepared to rip off the vulnerable, and you can’t get much more vulnerable than being the parent of a child diagnosed with cancer.

The family were clearly taken in by these claims, as their next move was to head for Mexico and the Oasis of Hope Clinic in Tijuana; these clinics were featured in the “Suppressed Inventions” book also. Again they got great coverage on Holmes and other media about their fight to protect their child, about the wonderful treatment they were having – reputedly for $45,000 a month – about the dreadful things that the cancer industry were responsible for in suppressing cancer cures.

The New Zealand Skeptics gave the 1998 Bent Spoon to Holmes for exploiting a sick child and desperate parents in the name of entertainment without asking the hard questions that needed to be asked.

And while all this was going on, paediatric oncologists around the country were treading very warily. In July, a six-year-old died following his parents refusal of radiotherapy. Doctors said that the Williams-Holloway case made them wary of acting in the best interest of their child patient. In the case of the 13-year-old mentioned earlier, the parents’ lawyer argued that it was the health authorities who were negligent in not seeking a court order to enforce treatment for the boy. They, too, had been scared by the fervent public opinion whipped up around the Williams-Holloway case.

We had a publicly funded documentary follow one woman through alternative therapy to treat a lump in her throat. No mention that the alternative healer also claimed to be regularly abducted by UFOs, no questioning of his claims that cancer is caused by bacteria, no questioning of the ethics of him prescribing 35 health supplements daily from a brand in which he had a financial interest. And how did this piece of investigative journalism end – with the conclusion that the reason her lump ended up bigger over the 16 weeks of treatment was because she hadn’t believed in it enough!

We now have parents on cancer wards torturing themselves for not offering their children a less invasive alternative.

Well, to cut a long and harrowing story short, Liam died recently in Mexico. He outlasted the oncologists’ predictions by about a year, which has been taken by some as clearly indicating that the alternative treatment was working. The fact that he has died, and made front-page headlines in doing so, may, I hope, cause others to think again.

Parents Exonerated

One of the most disturbing reactions I have seen to the news came from our Commissioner for Children, Roger McClay, a man who has had the highest profile in arguing for the rights of children, who has wept publicly over cases of child abuse. His response was to exonerate the parents once again because they had made “the right choice for them” and then, astonishingly, he added:

“Whether a different course of action would have been better, there’s not much point in worrying about it now.”

Well, I’m sorry Commissioner, but there’s a great deal to worry about. When you have medical professionals paralysed for fear of a public roasting, when you have alternative therapists seemingly having full access to national publicity with no fear of demands for proof of their claims, when you have people believing that there is some conspiracy by cancer specialists to suppress cures and harm children, then you’ve certainly got something to worry about.

The Need to Question

I believe it all comes back to that need to question, and to encourage others to question. After all, we all start off with a questing spirit. Babies explore their world, and anyone who has dealt with small children is well aware of their apparently endless store of questions about how the world works.

Somewhere along the way, many people lose that desire to know, to broaden their horizons. My mother, a primary school teacher for many years, reckons this loss happens when children start to ask questions which are beyond the scope or training of their teacher. Deceptively simple questions such as “why do clouds float?” and “what makes this light work?” reveal the questioning nature of a potential scientist and – all too often – the adult’s lack of knowledge.

Some people, whether parents or teachers, feel threatened by this. It’s seen as disruptive, irrelevant, potentially disrespectful. It gets in the way of the lesson plan, or interrupts the structured bedtime routine.

Yet it is these very aspects that make children so receptive to science, so able to question.

Science writer and physics professor Chet Raymo identified the habits of mind which children have at their most creative, and which are mirrored in the world of science:

  • curiosity
  • voracious seeing
  • sensitivity to rules and variations within rules
  • fantasy

He mourned having to teach undergraduates whose image of science was of a dull, dry, boring subject devoid of interest, to be endured and then forgotten in the interests of more lively pastimes such as astrology or parapsychology.

Instead, he said, we need to convey the adventure stories that make up science, the fantasy that forms it. Small wonder that he so often cites children’s literature, whether the works of Dr Seuss or Maurice Sendak.

“In children’s books,” he says, “we are at the roots of science – pure childlike curiosity, eyes open with wonder to the fresh and new, and powers of invention still unfettered by convention and expectation.”

Don’t Despair

So don’t despair if your kids are into the latest SF, Goosebumps or Harry Potter. That doesn’t mean that they will grow up to be would-be wizards or psychic investigators. What they will learn is that there are more things in the world, Horatio, than can be found within the pages of a school textbook, and that’s never a bad thing.

My kids first started asking about werewolves and ghosts after encountering Scooby Doo on television. I think Scooby Doo has been around long enough that most of us will have watched him and his gang of kids who, every episode, unmask the villain who’s dressed up in the wolf suit or the white sheet to frighten or con someone. I hadn’t thought about Scooby Doo as an agent of skepticism, but have to wonder about the creators of this show.

There are plenty of children’s science shows produced all over the world, but few take a direct look at things of a skeptical nature. My all-time favourite has to be “Oi” which, I am proud to say, was produced in New Zealand, and which has won awards internationally. In each 30-minute show it had a segment which was pure skepticism. If the New Zealand Skeptics ever get a major bequest, I’d like to put together a Greatest Hits of Skepticism using material from “Oi”.

I’ve had some small measures of success in subverting my own children. Davey was barely three when we were in a local bookshop and he paused before a display of that bastion of Australian culture, Bananas in Pyjamas.

“We don’t buy that,” he announced. “Why?” I asked. “Because it’s commercialization.” The lady next to us was startled but I was delighted – I’d been teaching David to be suspicious of the ploys of marketers. My kids know that the sweets at the checkout counter are a trick and are determined not to be fooled. They may look longingly at the chocolate bars, but it means I don’t get the whining which can be clearly heard emanating from the other aisles.

We often talk about what’s real and what’s not, whether it’s discussing Pokemon, the TV news, Halloween, dinosaurs or whatever has taken their fancy. My children are used to me equivocating – I’m happy to preface a response (note – not an answer, but a response) with “it depends”, “we’re not sure but…” or “what do you think?”.

Over the past couple of years, David and Perry have read and reread their way through Dan Barker’s guide for young skeptics “Maybe Yes, Maybe No” which sets out the basic rules of science:

  • check it out
  • do it again
  • try to prove it wrong
  • keep it simple
  • it must make sense
  • be honest

and which concludes “it is okay to say ‘I don’t know'”.

That’s a phrase I use a lot with my children, but I usually follow it up with “let’s see if we can find out”.

You see, one of my greatest delights is discovery – new facts, new words, new ideas – and I want to do my best to encourage that delight in my children.

It doesn’t take a good reference library or Internet access, though we’re lucky to have both available at home. It can be something as simple as a walk to school.

We talk about what the weather is doing, how clouds form, the difference between fog and smog. We peer cautiously at the various items of roadkill, and consider how death and decay is a part of life. The late arrival of the Sun over the sea in winter is a practical reminder of Earth’s movement around our star. The changing bird populations on the estuary mirror changes in the seasons, as do the annual cycle of the tomatoes grown in the large glasshouse on the corner.

Pure Joy

I get pure joy when I ask David why he thinks such-and-such happens and get a gratifying moment of thoughtful silence before he makes the attempt to explain. It’s not a matter of getting things “right”, though it’s a delight when he does. It’s more a matter of virtually seeing his thought processes at work, of experiencing that fresh interest when all is new.

We do get odd looks from other pedestrians who are busy hurrying on their way. They see us examining the death mask of a hedgehog by the side of the road or stirring an oily puddle with a stick, but they don’t see our joy of discovery as we discuss why a hedgehog’s teeth are so sharp or what makes the colours on the puddle’s surface.

There’s an adage that one should “stop and smell the roses” – but you can do so much more. Why do the roses smell like that? Why aren’t roses shaped like cornflowers? Why do they have thorns?

We mightn’t be able to answer every question, but it’s the journey to those answers that provides the excitement. It’s a journey on which, as a parent, I am privileged to be accompanied.

A Year Of Mussels & Chardonnay

Vicki Hyde presents the year 2000 chair-entity’s Report

I’m pleased that we all appear to have survived the Millennium melt-down and will have to wait another thousand years for the sky to fall in. Apart from the pre-millennial party at the beginning of the year, the past 12 months have seen “business as usual” on the skeptical front.

Alternative treatments continue to get highly positive and highly uninformed media coverage. The Minister of Health has announced a study into alternative treatments and their efficacy. As more and more of these enter the public health system, apparently in response to public demand, I urge you to make your public voice heard. Please write to the minister or your local MP expressing your concerns.

At least one can see a ray of light in the prosecution of the company touting Lyprinol mussel extract as a cancer cure; though one has to note that they were fined $5000 and reports had sales of $1.2 million in the first few frenzied days of product release. Of course had TVNZ had a journalist with science training on the job, it would have been a non-starter and certainly wouldn’t have got the extended lead story coverage it did get.

It’s not just TVNZ though. TV3 had the documentary Gabrielle’s Choice, regarding a woman’s decision to try the alternative route in treating a suspected cancer. It came to the appalling conclusion that, having made the choice to undergo 17 weeks of Rife radio frequency treatment, oxygen therapy, multi-vitamin and herbal dosages etc, the reason these things didn’t work in reducing the lump was because Gabrielle didn’t believe hard enough. It was all her fault.

Fault-finding is an interesting past-time, if somewhat arbitrary. I see that the religious Samoan family who took their 14-year-old out of cancer treatment are now on trial for his manslaughter. No tear-jerking coverage on Holmes for them.

Our criticism of the Wellington’s healing touch “therapy” hit a raw nerve with Holmes. His outburst about the Skeptics being a bunch of “white-skinned, chardonnay-sipping elitists who should crawl back to the Arts Centre and get a life” was shortly followed by the announcement that he was taking extended leave to undergo conventional treatment for his own cancer. It should be noted ratings rose 10% in his absence.

We didn’t get asked back on to Holmes to examine our track record in the psychic-skeptic predictions made at the beginning of 1999. Regarding those, I take full responsibility for the All Blacks’ loss to France in the World Cup semi-finals, as I obviously jinxed the team. It would have been nice to know if the psychics had come up with an equally stunning prediction.

The primer continues to provide a useful teaching tool, and I have hopes for two more projects I would like to ask your support for. One is a small resource for libraries to encourage them to think about their book collection and cataloguing. Do they really need 174 books on astrology? That’s grown out of a presentation I made to the librarians at Canterbury Library, one of whom came up with the rather innovative idea of cataloguing the books under “fiction, non-fiction and crap”.

The other project is for you to consider a Web-based database of the NZ Skeptic, so we can all easily find material that has been published over the past 10 years and have fast reference to discussions of all the topics that come up time and time again. It would certainly make my life easier, and I suspect would be a very useful resource for all of us.

Your chair-entity,
Vicki Hyde

A Bitter Pill?

The risks of third-generation contraceptive pills have been much in the news. But assessing risk can be a tricky business.

Twenty-nine years ago, I was about a week into my first job as a doctor, as a House surgeon in orthopaedics at Guy’s Hospital in London. I had not had time to get to know the patients under my inexpert care and was on a very steep and stressful learning curve. Just before three in the afternoon as I was doing my post-operative round, my bleep went mad, warning me of some dire emergency. I hurried to the men’s ward to find an anaesthetist and another doctor working hard to revive a man who had suddenly called out and then fallen back pulseless. He had had a knee operation the week previously, before I had arrived on the job and I scarcely knew his face, let alone his name. My puny contribution to the efforts of the experts were to no avail and his circulation could not be restored. His wife was waiting outside and it fell to me to tell her that he had had some sort of heart attack and had died. You will not be surprised that it is her face rather than his that I remember.

Twenty-five years later, another patient in my charge, a young student of twenty, had puzzled two other doctors by her sudden attacks of loin pain over several weeks, first on the right side, then on the left and then on both sides. By the time she came to see me, she had had numerous blood tests, an emergency kidney x-ray and a chest x-ray. They had given no clues as to the cause of the pain. She had been seen in the Accident and Emergency department of the local hospital in the middle of the night. She had been seen by a colleague of mine at the weekend. The attacks continued, but in between them, she had been well enough to go out on Territorial Army manoeuvres. When she saw me, the pain was bad enough to make her catch her breath. Apart from severe muscle spasm and a raised pulse rate I could find no abnormality. I noted that “something strange is going on here.” I arranged for her to see a medical specialist urgently. Before she could keep the appointment, while walking from the library to the cafeteria, she fell pulseless to the ground and her circulation could not be restored.

Venous Thromboembolism

Post-mortem examinations showed that what both these unfortunate people had in common was deep venous thrombosis and massive pulmonary embolism, first elucidated by the great German pathologist Virchow, well over a hundred years ago. Venous thromboembolism, as it is often called, VTE for short, has vexed doctors ever since.

Most of you will know that blood outside the body clots. It is fortunate that while in the blood vessels it does not usually clot unless the vessel is damaged and then clotting is indispensable. The damage results in the release of substances that initiate a cascade of biochemical reactions that result in a tangle of a fibrous protein called fibrin, mixed up with platelets and red blood cells. This plugs the hole in the vessels and may plug the whole vessel. Virchow’s triad has stood the test of time as an analysis of what happens with abnormal clotting. He observed that the main influences are disturbances of the vessel wall, things that change the dynamics of the blood flow and things that change the components in the blood that initiate clotting. Let us return to my two unfortunate patients.

Contributing factors

In the case of the first, he had had an operation on a lower limb and his limb had been immobilised in plaster. The stress of an operation in itself increases the clottiness of the blood, muscle action would have been absent during the operation and reduced after it, leading to sluggishness of flow. We can imagine what happened in the veins of his legs with clotting extending from a vein, often starting in a valve pocket, and eventually extending into the main vein of the leg and thence even into the main abdominal veins. Eventually, a large piece broke off, was pumped through the right side of the heart, blocked the pulmonary trunk and brought circulation suddenly and permanently to a halt.

The second person was a fit and healthy young woman. Were there any known predisposing factors? Had she perhaps an inherited predisposition for her blood to clot easily? Her grandfather had had an uncomplicated deep vein thrombosis after an operation on his leg, but this is a known risk. Had she had any injury? Well, she had sprained her ankle on Army manoeuvres four weeks before she had started to get symptoms. Following her death, her Lt Colonel investigated this and there is nothing in his detailed account to suggest that she had anything other than a minor sprain.

She had not sought any medical attention for it. And three months previous to her death, she had started to take the contraceptive pill.

Popular Pills

The first major trials of the contraceptive pill took place in the late 50s and it quickly became very popular because of its ease of use and near 100 percent efficacy. It contains two hormones, progestogen to fool the pituitary gland into thinking the taker is pregnant, so that it has no need to send signals to an ovary to release an egg; and oestrogen to give cycle control so the taker can have a monthly pseudo period. The oestrogen component also reinforces in some way the contraceptive efficacy of the pill. The first pills used about six or seven times as much oestrogen hormone as modern pills and the first case histories suggesting an association between the pill and VTE appeared in 1961. A report to the British Medical Research Council in 1967 showed a clear link between pill use and VTE and further papers from Britain, Sweden and Denmark in 1970 concluded that the risk of thrombosis was linked to the oestrogen dose. By this time, the oestrogen dose was down to about 80 micrograms from an initial 180 to 200 micrograms and it was then recommended that the level at which risk became unacceptably high was about 50 micrograms of oestrogen.

Absolute Risk

Early case-control studies suggested that the risk of VTE was between two and eleven times greater in pill-taking women and the absolute risk was between three and six episodes per ten thousand women per year. A large study of 65,000 women in Seattle in the early eighties suggested a relative risk of 2.8. Healthy women not on the pill seem to have an absolute risk of about one per thirty thousand women per year, so the risk in pill-taking women is about one per ten thousand per year. I should make it very clear at this point that we are not talking about risk of death here, but only of deep vein thrombosis. If we take the worst figure, about one in fifty of people who get deep vein thrombosis will have a fatal pulmonary embolus, so the risk of death from this per year of pill use is about one in a quarter of a million per year. However, a further proportion of people who get DVT will have permanent damage to the veins of their legs and in some, multiple small clots breaking away will cause permanent damage to the circulation of the lungs. Pills containing progestogen on its own do not seem to have an increased risk of VTE, but are less effective and periods are irregular, so they are less popular.

Late in 1995 media reports began to appear that so-called third generation oral contraceptive pills carried a greater risk for VTE than the older pills. The third generation pills contain the progestogen hormones gestogene or desogestrel, which can be thought of as designer hormones. The state of the art of drug synthesis has advanced to the point where the properties of the hormones can be to some extent predicted from their structure, and vice versa, and these two hormones have fewer male-hormone like effects (such as causing acne etc) and less effect on fat and carbohydrate metabolism. They were promoted as being safer for the arteries, where blood clots also occur, as in heart attacks and strokes, and better for the skin. It was difficult for doctors to advise their patients as the papers on which the media reports were based had not been published, but three eventually appeared in the scientific medical journal, the Lancet, of December 16, 1995 and another one in the British Medical Journal in January 1996. They are not easy reading and I think it is safe to say that those most likely to prescribe the contraceptive pill, general practitioners, do not as a rule read the Lancet.

Literature Reviews

Fortunately for us, there was no shortage of secondary articles, and one appeared in the Ministry of Health’s Prescriber Update in February 1996. I have read the original papers and can say that the article is an excellent and balanced summary that accurately reports the findings of the originals and correctly reflects the views of their authors. The risk of VTE in second generation pills is less than previously reported. A healthy woman who is not a current user of the pill has an annual risk of VTE of about one in 26,000. A woman who takes the modern second generation pill has an annual risk of about one in 6 to 10,000. Someone who takes a third generation pill has an annual risk of between one in 3,570 and one in 5,000, so the risk of VTE in third generation pills is roughly twice that of second generation pills. The authors echo a Lancet Leading Article in stressing “that further independent study is necessary. The interpretation of the small increase in risk of VTE must be weighed against a possible decrease in the risk of other cardiovascular endpoints. Until the relative risk of other important health outcomes such as stroke or coronary artery disease.. is clarified, there is no sound basis for recommending any change to current contraceptive practice.”

British Response

In Britain, the response of the Ministry of Health was to advise that the third generation pills should not be used by women with additional risk factors for VTE and that doctors should prescribe them only for women who were prepared to accept the increased risk and who were intolerant of other combined pills. This led instead to widespread flight, not only from third generation pills but from contraceptive pills in general, with at least anecdotal reports of many accidental pregnancies and an increase in abortions. This may seem very strange to aliens like us who habitually think logically, but you will not be quite so surprised if I said that following a recent total solar eclipse in Britain, people sought advice as to whether viewing the eclipse on television could have caused damage to their eyes…

In New Zealand, the response was more muted. Doctors took the advice from the Health Department at its face value and received it as a reminder to check for risk indicators when prescribing the pill. In December 1998 we were told between January 1993 and June 1998 there had been six deaths from VTE in women taking the third generation pills whereas between 2.2 and 3.7 deaths in this time would have been expected. Of course, with such small numbers the figures could readily be accounted for by random variation and the article pointed out results from epidemiological studies are more reliable than Committee for Adverse Reactions Monitoring data. The waters were by now quite muddied and Sandra Coney jumped into them last year to further stir them up when the headline of her column in the Sunday Star Times read “Who’s to Blame for Pill Deaths?”

“My question is”, she wrote, “who is accountable for these deaths? Is it the drug firms who raised the spectre of legal action against the Ministry when it planned to issue warnings when the risk of these pills were first known?

“Is it the medical groups who pressure the Ministry by saying they would disassociate themselves from the advice? Or is it the various officials of the Ministry of Health who caved in under the pressure, selling New Zealand women down the river?”

She pointed out that “an astounding 75 to 80 percent of women” using the pill in New Zealand were on third generation pills. “This”, she said, “tells us something about the too-cosy relationship between doctors and drug companies in New Zealand.”

According to Coney, the Adverse Reactions Committee had advised doctors should preferentially prescribe the older second generation pills, but the pill manufacturers threatened the ministry with legal action and had “bombarded GP’s with dossiers contradicting the studies” and the Royal New Zealand College of Obstetricians and Gynaecologists said they would publicly dissociate itself from the advice. The Family Planning Association, another body that might be thought to have some expert knowledge too, “went about saying the studies…were affected by biases so that the results couldn’t be trusted.”

Rhetorical Questions

At the end of her article she asks questions that might be thought to be mildly rhetorical given the general tenor of the article. Of women using third generation pills she asks:

Are they warned of the risks?

Do they know that they could reduce their risk by using older forms of OC’s or even eliminate it by using another method?

Have their doctors explained to them the symptoms of blood clots?

Do they know they are at additional risk if they are immobilised because of illness, injury, surgery or a long plane flight?

What must we poor benighted doctors do as dossiers rain down about our ears from drug companies, as sticks labelled “informed consent” are waved at us by the Health Commissioner, as our expert bodies display their ignorance by echoing the advice given by other expert bodies throughout the world?

The publicity has had a beneficial effect in making us more careful in assessing people’s suitability for the combined pill, but it may have led us to practice a more defensive style of medicine. In a consultation I have about twenty minutes to impart quite a lot of information and know that seventy percent of what was absorbed at the time will have been forgotten by the end of the day.

Reduced Risk?

Could they indeed reduce their risk by using an older pill? One expert, Walter Spitzer, commenting in the Lancet on a World Health Organisation scientific summary writes “The summary of the conclusions plays down the controversies that have raged for the past two years about differences between second and third generations of oral contraceptives in risk of VTE. It also properly emphasises the rarity of all the three serious side effects.” He went on to point out that there is at least some evidence that third generation pills may have a smaller incidence of heart attacks in young women and that the order of risk for VTE and heart attacks is about the same. What we may gain on the swings of reduced VTE we may lose on the roundabouts of heart attacks.

If we look at risks in isolation we may reach conclusions that are both correct and yet which are absurd. Let us suppose that a sexually active woman decides that the risk of OCP is too great and so she uses no contraception at all. In a year she has a seventy percent chance of getting pregnant. During the pregnancy she has a one in 1600 chance of getting a DVT and during the week in which the baby is born a risk of about one in six hundred, roughly ten times greater than the worst risk for third generation pills – if the studies have reached a correct conclusion.

Symptoms

Every third year medical students knows the symptoms of blood clots. You get a painful swollen leg with tender calves. Unfortunately for us poor benighted doctors and unfortunately for our patients, most people with DVT don’t have these symptoms and most people with these symptoms don’t have DVT. Pulmonary embolus is even more difficult to diagnose without high tech help – except in the post-mortem room. Oh, if only the drug firms would distribute free retrospectoscopes instead of raining dossiers of propaganda on me! Still, I do tell patients, orally and in writing, about painful swollen legs; and chest pain with shortness of breath and spitting of blood; and about sudden loss of vision or use of limbs. If I set a test at the end of a week not many would pass. But I’ll be OK when the Health Commissioner comes calling.

Do I really have to tell them about additional risk if they are immobilised because of illness, injury, surgery or long plane flights? My elder daughter flew to Britain a few months ago. Would I as a doctor expect her doctor to suggest that she stop the pill (I don’t know whether she’s on it. It’s none of my business). First of all, long distance flying carries a risk of DVT that is independent of being on the pill, so I should also expect him also to warn her about the risk of cosmic rays at high altitude, the risk of side-stream smoke in the cabin, the risk of acquiring hepatitis A from eating airline food and so on almost ad infinitum. In any case, it’s a risk that she would run for a few days at most, so it would have to have a very high annual risk indeed to be of comparable significance to the annual risk from the pill.

To Sandra Coney and others the issues seem to be simple. One sort of pill carries twice the risk of another sort. Drug firms have bullied the Ministry of Health and have muted the voice of doctors and other experts by stopping their mouths, not with gold, the preferred substance for scoundrels down the ages, but misleading dossiers. A risk is a risk is a risk and no one should have to run it if it can be reduced. No matter that people vastly better informed and experienced in analysis of statistics comment about the “lack of clinical importance and public health significance of VTE” with its “very low absolute rate of occurrence, low morbidity and low case-fatality.” Nothing must get in the way of a good story.