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As someone currently enduring a bout of shingles I have a few comments to make on the excellent article on the bad science behind the vaccine scare (NZ Skeptic 100). Further to benefits of vaccination mentioned in the article I think the point should be made that viruses can actually be eradicated from humanity which is ironic since they cannot, unlike bacteria, be killed as they are not living entities. Bacteriological diseases on the other hand are treatable and curable but the infectious agents cannot be eradicated.

Of course we are beginning to reach a point where some bacteria are resistant to most, if not all, current antibiotics thanks to misapplication, abuse and ill-informed prescription by doctors who should know better.

The damage done by the originator of the vaccination scare is incalculable. I don’t think being struck off the medical register is enough – I have long held the opinion that anyone earning a degree on the back of research which is later invalidated should be stripped of their degree and in the case of this man I think an apt reward would be the loss of his doctorate and professorship. He has demonstrated an inability to do good research and should not be overseeing students doing theirs.

I further think that vaccination should be done by law and the decision taken out of the hands of well-meaning but deluded parents who don’t realize that they don’t know what they are doing. Vaccination is a public health issue and there is no reason it shouldn’t be mandated in order to prevent children from contracting diseases they need not suffer and as a useful step to eradicating infectious agents. The payback in terms of saving tax expenditure and avoiding misery for children is huge.

I was lucky that my parents saw we were vaccinated against everything for which vaccines had been developed at the time and I am delighted that the common ‘wisdom’ of ‘once you’ve had it you are immune for life’ has been effectively thrown out forever. I well remember my best friend’s mother being crippled as a result of having contracted poliomyelitis in her childhood. It was a tragedy which need never be repeated in this day and age.

And anyone who thinks that talk of eradication is mere cant should think again – look what has happened to smallpox with a bit of directed will and determination. And in case anyone reading this doesn’t know it, the condition I am currently suffering from is caused by the chickenpox virus I contracted over 50 years ago. It has been lying dormant in my nervous system where the body’s immune system cannot get at it. I have so far suffered relatively lightly but a bout of severe nerve pain could ensue. I am not looking forward to the possibility and am hoping for the best but am prepared for the worst.

Malcolm Watts

Placebo effect quantified

It’s not often that we obtain numerical information about the strength of a placebo effect. Thus we should applaud the manufacturers of Voltaren for their webpage www.voltarengel.com/ hcp/ efficacy.aspx (“Direct route to relief”).

Under a caption “Patients experienced a 51% improvement in [osteoarthritis] knee pain …” is a bar graph that shows both a 51 percent improvement with Voltaren gel and a 39 percent improvement with placebo gel. (Treatment period was 12 weeks.)

Similarly, “a 46% improvement in … hand pain …” turns out to be 47 percent improvement after six weeks of using Voltaren gel versus 40 percent improvement with placebo.

To simple-minded people like me, this sounds like a Voltaren effect of 12 percent for knee pain and 7 percent improvement for hand pain. I’m not knocking Voltaren, which I use myself, but clearly external use of the gel is not necessarily superior to taking this medication by mouth.

To the practitioners of alternative medicine, these results are wonderful. Regardless of treatment, after four to six weeks hand pain will be significantly reduced. Similarly a few months of quack therapy will reduce knee pain by almost half.

Jay D Mann
Christchurch

The physiology of the placebo effect

Placebos may contain no active ingredients, but they have real effects on the human brain. This article is based on a presentation to the NZ Skeptics 2008 conference in Hamilton, September 26-28.

Earlier this year, Dr Tipu Aamir of the Auckland Pain Management Service drew my attention to something peculiar. In a double-blind, randomised, placebo-controlled trial of morphine after a standard knee operation, 30 percent of those receiving a placebo get pain relief. When those people are given a specific morphine antagonist (‘antidote’), their pain comes back! In the words of a former contributor at an annual conference of this society, this was an epiphany. I needed to know more.

After all, how could something that was ‘all in the mind’ be changed predictably by a substance with a known pharmacological action?

Any study of homeopathy raises the issue of the placebo effect. As a result of a meta-analysis in 2005 of a number of studies comparing homeopathic remedies with orthodox treatment, Shang et al stated in their conclusion that the effect of homeopathic remedies was no greater than that of a placebo. Not that they had no effect, but it was no greater than that of a placebo.

We skeptics are often happy to accept the explanation that if a response to some arcane practice is a placebo response, that settles the issue.

Over the last 30 years there has been a large amount of research into the undoubted effects of placebos. I thought it might be of interest to review this work in the context of our frequent use of ‘placebo effect’ to explain the unscientific.

Placebo is a Latin word for “I shall be pleasing, or acceptable”. It is the first word of the first antiphon of the Roman Rite of the Vespers for the Dead (!), Placebo Domino, dating from the seventh to ninth centuries. Chaucer called one of his characters Placebo in the Merchant’s Tale, because the word had come to mean a flatterer, a sycophant, or a parasite, by the 14th century.

“Placebo seyde: Ful little need had ye, my lord so deare, Council to ask, of any that are here But that ye be so ful of sapience.”

He also uses it in the Parson’s tale: “Flatterers be the Devil’s chaplains, which sing ever ‘Placebo’.”

In the 1811 edition of Hooper’s Medical Dictionary, placebo was defined as “an epithet for any medicine adopted more to please than benefit the patient”. In a recent edition of Collins’ Concise Dictionary of the English Language it is defined as “an inactive substance administered to a patient to compare its effects with those of a real drug, but sometimes for the psychological benefit of the patient through his believing he is receiving treatment”.

However, placebos do benefit patients, and they are certainly not inactive in the context in which they are given.

The most dramatic example of this that I saw in clinical practice involved a young man on artificial kidney treatment. When erythropoietin became available for the treatment of the severe anaemia seen so often in this situation, he was the first patient in our unit to receive it. Erythropoietin is a hormone made in the healthy kidney, which increases the number of red cells in the blood and the amount of the oxygen-carrying haemoglobin. The synthetic version has achieved notoriety as a performance enhancer in sport, for example in the Tour de France. We were all very enthusiastic about this improvement in management for our patient, and he was given his first dose with much interest from all of us. That night he went home, recovered his bicycle from the shed where it had been undisturbed for many months, and rode all around his town with great energy and pleasure. He hadn’t heard the information that the drug took three weeks to act on the anaemia.

We are left with some questions. What was the physiology of his sudden ability to exercise at a ‘normal’ rate, long before there was any change in his blood count? What does ‘it’s all in the mind’ mean? Was he somehow at fault, or was it me and the staff who were lacking in understanding?

I would like to consider:

  • The psychological processes involved in the placebo effect
  • The physiological mechanisms in the brain
  • The site of this activity in the brain
  • Why there is variation in the placebo effect from individual to individual
  • What are the implications for the classical drug trial format?

Psychological mechanisms

Those who study the psychological processes of the placebo effect cite two major mechanisms.

Conditioning. Pavlov (1849-1936) showed that dogs given meals as a bell rang would subsequently salivate when the bell rang despite not being given food. This process has been explored in humans, who will experience pain relief when a placebo is substituted for a pain reliever when a sequence of active analgesia has been associated with an environmental cue. It is an unconscious process. At the nerve cell level, conditioning leads to a stronger and more sustained response.

Expectancy. This effect is seen when the patient has ‘great expectations’ of the substance being given. These are raised by the conscious or unconscious attitude of the therapist. It is a conscious process on the part of the patient.

It is currently suggested that both conditioning and expectancy are active in the placebo effect, and that in fact, as an inert placebo can have no effect per se, what we see is the effect of the context in which the treatment is given.

Neurophysiology of placebo pain relief

Over the last 30 years, there has been much interest in the neuro-physiological mechanisms of the placebo response.

In 1975, Hughes et al identified in the brain two related pentapeptides (a chain of five amino acids linked together) with potent opium-like action. There are many more now identified. These compounds act on specific receptors on the membranes of neurones, and via intracellular metabolic changes increase synaptic transmission. They are made in the pituitary and hypothalamus, and are called endorphins.

A digression

In pharmacology the term agonist denotes a drug with an effect, and antagonist, a drug which specifically blocks the effect of the first substance.

When I spent a year in the pharmacology lab in Dunedin (1959) it was becoming recognised that drugs exerted their effects by way of a specific receptor molecule at the cell surface. The actions of adrenaline, for example, were explained by the presence of two different molecules to which it could attach, which mediated different effects. Noradrenaline would latch on to only one, explaining its more limited range of action. With their usual desire for learned coherency, pharmacologists called them alpha and beta receptors. Antagonist molecules attach to the receptor molecule and block access by the agonist. Hence the term ‘beta-blockers’. These are substances which block the action of adrenaline on its beta receptor. They are widely known for their action in the control of blood pressure, and recently for their unwanted effects when given to protect patients at risk of heart trouble when undergoing operations.

Agonists and antagonists are related by similarities in molecular size, shape, and charge.

Morphine antagonists have been available for some time. In 1961 as a house surgeon in casualty, I was asked to manage an opium addict, brought in because he was deeply unconscious, and breathing perhaps once a minute. He had been without the drug for some weeks, due to market fluctuations. When access was resumed, he used a dose which was the same as his habituated dose. This was much more than he could now tolerate. I had access to nalorphine, a specific morphine antagonist, and 30 seconds after an IV injection, the patient took several deep breaths, sat up, expressed considerable surprise at his surroundings, and then lapsed back into his former state. I was able to repeat this dramatic procedure several times until he recovered!

In 1978 a group of dental surgeons working in California (Levine et al) carried out the following experiment. Patients who had had an impacted wisdom tooth extracted were treated routinely with nitrous oxide, diazepam and a local anaesthetic. At three hours after the procedure they were given either a placebo or naloxone, a specific morphine antagonist. At four hours they were given a placebo or naloxone. Those who had initial pain relief with the first dose of placebo (39 percent), when given naloxone had an increase in pain.

The authors concluded that “this was consistent with the hypothesis that endorphin release mediates placebo analgesia in dental postoperative pain.”

The elegance of this study lies in the unequivocal evidence that a supposedly psychological state (placebo analgesia) was reversed by a specific opioid antagonist. Note that none of the patients was given morphine. There must be a physiological cause for placebo analgesia.

This sort of study has been repeated many times, and always naloxone reverses placebo analgesia.

The site of action of opioids in the brain

The site of this process has been determined. The sites for opioid receptors in the brain can be found by specific cell staining methods and histology on brain tissue. But more exact, ‘real-time’ evidence comes from positron emission tomography (PET) scans.

Another digression

PET utilises short half-life radioactive elements which undergo spontaneous beta decay. In the process, they emit a positron, which collides with an adjacent electron resulting in mutual annihilation, and the generation of two high-energy photons at a near-180 degree angle. These can be detected, and with many, many such events, used to build up a tomographic picture of the source in relation to surrounding tissue. In the studies of the brain, radioactively-labelled glucose is injected, and congregates where activity (utilisation) is greatest. PET scans are used to monitor metabolic activity in specific organs. For example, the extent of heart muscle damage after a heart attack.

In 2002, Petrovic et al were able to show that both opioid and placebo analgesia are associated with increased brain activity in specific regions: the anterior cingulate cortex and the brain stem. There was no increase of activity in these regions with pain only.

Similar localised brain activity has been shown in placebo responses in Parkinsonism (dopamine) and some depressive states (serotonin).

I find these studies exciting and provocative.

Genetic predilection

A further question can be asked in the light of the evidence for a physiological mechanism for the placebo effect. Why does it occur in only 30-40 percent of us for a given situation? It may occur in a greater proportion of a population sample if the context is made more convincing. But why don’t we all have the benefits? Variation in a physiological function begs the question of a genetic predilection.

De Pascalis et al (2002) have shown that individual differences in suggestibility contribute significantly to the magnitude of placebo analgesia. The higher the suggestibility score (there are several tests available) the greater the placebo analgesic effect.

As early as 1970, Morgan et al showed that there was a correlation of suggestibility between monozygotic twins but not dizygotic (fraternal) twins. (Monozygotic twins are the result of the fertilisation of one ovum by one sperm. The resulting zygote splits into two cells which each develop into an individual. These individuals have exactly the same genes.)

Wallace and Persanyi (1989) looked at hypnotic susceptibility and familial handedness. Subjects with close left-handed relatives scored lower in a test for hypnotic susceptibility.

At the 2008 conference, I carried out an experiment with a group of clearly non-suggestible Skeptics. I asked those in the audience to raise their hands if they, or a close relative, were left-handed. If the hypothesis was correct, more than 10 percent of our attendees should have been left-handed. In the event, 22 of 84 attendees indicated they or a close relative were left-handed.

The control study should be done with a church congregation, Protestant or Catholic. In fact, we could do this on both and answer the question as to which is the less suggestible! I haven’t had the nerve to ask. Thomas Bouchard, beginning in 1979, has carried out a number of studies on twins who for a variety of reasons were reared apart. He compared correlations between identical twins and between fraternal twins. The studies from his group (in Minnesota) have shown a large group of correlations in identical twins reared apart, which do not occur in fraternal twins reared apart. The correlations differ very significantly. Table 1 has some examples in twins reared apart:

Similar studies have given similar results in Australia and Western Europe.

Because the nurture of these twins is different, and identical twins have identical genes, the similarities must be genetic. This approach to behaviour has lead to the science of behaviour genetics. (Physical attributes are of course also correlated more between identical twins reared apart, than fraternal twins reared apart.)

Amir Raz (2005, 2008) and his group in New York State have shown that a genetic polymorphism (more than one version of a specific gene) exists for a gene on chromosome 22, which codes for an enzyme active in the breakdown of dopamine, a neurotransmitter. One amino acid substitution (valine for methionine) in the gene alters the enzyme activity by a factor of four times. Since we have a copy of this gene from each parent, we may have val/val, or val/meth, or meth/meth genotypes.

Val/meth heterozygote confers the greater suggestibility. The enzyme is called COMT or catechol-o-methyl transferase.

Brain pathways in which opioid receptors are active are linked to those in which dopamine is the transmitter (nerve to nerve). If there is genetically conferred variation in dopamine activity it is likely that this will influence the result of changes in activity in the opioid pathways.

We must remember that we are talking of a genetic predisposition to be suggestible, and not a gene for suggestibility. It is not that 69 percent of identical twins vote Republican, but that if one does there is a 69 percent probability that the other one does too.

The implications for drug trials

In 2003, Benedetti and his colleagues in Turin examined pain relief in patients after thoracotomy. Patients were allocated to either open infusions of morphine, with information about the efficacy of the drug, or to receive hidden doses of morphine by infusion without any information and without any doctor or nurse present (the open / hidden model for drug trials).

With the same dose, same infusion rate, same timing and same drug, pain relief was less in the ‘hidden’ group.

In the ‘open’ group, the ‘meaning-induced’ expectations had enhanced the drug effect.

This research group has gone on to postulate that in all drug treatment the effect is the sum of actual physiological effect and the effect of expectations. This means that the placebo effect will always cause part of the usual ‘physiological’ response to active drugs. They say that the classical double blind randomised placebo-controlled trial does not allow for expectation effects, and may suggest that a drug has a specific effect gre’open/hidden paradigm’ will give more meaningful results.

Conclusions

  • The analgesic placebo effect is accompanied by a distinct, observable, and locatable physiological event in the brain.
  • Susceptibility to the placebo effect varies in the population at large.
  • This susceptibility is at least in part genetically determined.
  • It may be possible to harness this facet of human behaviour for the benefit of individuals, and to prevent its on-going exploitation by charlatans.
  • Although placebos are inert and cannot have any effect on the healing processes, their meaning and the context in which they are given can.
  • All drug effects include some placebo effect, except when the drug is given surreptitiously. This should alter the classic clinical trial structure.

We have come a long way from the Vespers for the Dead!

Placebos are inert substances but the context in which they are given can alter neurophysiology in such a way as to cause subjective and objective effects.

This is not due to the ‘molecular memory’ of water, nor to strange force-fields as yet unknown to physicists. It is due to our human nature, how we react to our environment, and the relationship, between our minds and our bodies.

Full references available from the editor.

Hokum Locum

Yet another military syndrome


I imagine that most people joining the Armed Forces would expect the likelihood of a posting to an area of conflict. I know I did. I spent six months in Iraq between the two Gulf Wars. I admit that it was stressful but it was also one of the most exciting and interesting experiences that I have ever had. But that’s another story.

It appears however, that many would prefer a safe posting at home, typing memoranda or serving tea in the mess. The only risks from these activities are RSI or perhaps a minor burn from slopping the tea. When military personnel are posted to an area of conflict this comes as a shock. Compensation is fortunately available. It appears that shell shock and post traumatic stress disorder are passé. The new ‘buzz diagnosis’ is MTBI, or ‘mild traumatic brain injury’.

The cause is blast from roadside bombs and this can lead to “memory loss, depression and anxiety”. The US has instituted a screening programme for those returning from active service and they estimate as many as 20 percent may be at risk of MTBI. The UK MOD remains skeptical and is quoted as saying: “It is a very complex area. We have no way of knowing whether (the US assessment) is accurate because there is a level of dispute as to what constitutes MTBI.” You could apply the same logic to stories of alien abduction.

Skeptics could note that the diagnosis is largely subjective but should be alarmed that therapists such as Kit Malia are poised to cash in: “If the American figures are correct, this is massive, absolutely massive.” More work for the army of counsellors.

As the saying goes, war is hell. Many returned servicemen will tell you that and they fervently wish for an end to all conflict. Instead of pursuing this aim, we continue to send young men and women to various hell-holes and wonder why they fall apart. It is hardly surprising that they choose to fall apart in culturally acceptable ways with diagnoses such as GWS, PTSD and now MTBI. Screening programmes, websites and a telephone help line will ensure that those suffering from MTBI are suitably coached into supplying the right symptoms of this disorder.

When I read about these daft syndromes, I often think of my late father who experienced combat as an infantryman in World War Two. He came home, resumed his career and the only disability he had was spinal tuberculosis, contracted in Japan while serving with the occupation forces. The only compensation was the opportunity for resuming academic studies. Perhaps we could retrospectively label this ‘mild tubercular back injury’.

Today’s military personnel are not conscripted. They have a choice. I say, take the money and accept the consequences. Let’s either call an end to absurd diagnoses such as MTBI, or have the moral courage to eschew warfare and refuse to send our men and women on such missions.

The Guardian Weekly Vol 177 No 20 p11

Sensory Processing Disorder

Some children become upset when confronted with new sounds or places. They scream and misbehave. This behaviour is set to become yet another disorder of childhood-‘Sensory Processing Disorder’. Advocates are pressing the American Psychiatric Association to include this condition in its manual of mental disorders. Sound familiar?

Therapists have already set up clinics to deal with this new ‘disease’. One such clinic is Paediatric Potentials, where children experience play therapy including a spandex cocoon that can calm them. The condition was studied in the 1960s by a psychologist who called it ‘Sensory Integration Dysfunction’.

This has all the hallmarks of a fad diagnosis. The symptoms and signs of the condition are completely subjective. The condition relies on interpreting extremes of behaviour as being pathological. Physician enthusiasts are recruited to popularise the condition. Pressure is put on the relevant authorities to endorse it. This is precisely the path that led to the diagnostic labels of PTSD and ADHD. It appears that some academics are incapable of understanding normal human behaviour.

I’m still waiting for alien abduction to follow the same pathway to recognition. It’s just as valid as Sensory Processing Disorder.

Marlborough Express 15 November 2007

Are your children reaching their full potential?

So reads the advertisement from a local pharmacy. Perhaps this is the solution to SPD? For only $20 you can get 60 capsules of ‘Clever Kids Omega 3’. This product has been designed to “help support brain development and learning ability, including concentration, memory and problem solving, and may assist in the temporary relief of mild anxiety and irritability.”

This is the perfect product for families where parents are too busy to have time to interact with their children. If anybody could be bothered to test this useless product, I predict it will have no advantage over placebo.

Ritalin Substitute

Pharmac, the Government’s drug buying agency, is constantly looking at saving money on our huge national drug bill. Ritalin (methylphenidate) has been supplanted by a cheaper generic equivalent, Rubifen, which is one million dollars a year cheaper. Methylphenidate is used in the treatment of ADHD, another fad diagnosis like SPD. Parents remain unconvinced and many are demanding a switch back to Ritalin. This is typical of placebo dependence where people become convinced that the new small yellow pill is somehow inferior to their familiar big red pill. Given that ADHD is an entirely subjective disorder it is not surprising that there is a subjective obsession over the familiar drug versus a generic equivalent.

While I’m on the subject of useless products …

Red Bull OD

An Australian man drank eight Red Bull energy drinks in five hours and suffered a cardiac arrest while competing in a motocross event. This equated to a caffeine intake of 400mg which is close to the toxicity level for an average adult. The label warned against consuming more than one to two cans or bottles of the product per day. The victim was quoted as saying he drank four Red Bull drinks per day because “With the work I do I don’t have a lot of time to eat.” On the day of his acute illness he suffered a cardiac arrest and required defibrillation. He admitted to consuming eight Red Bull drinks over a five-hour period as follows: “It was to get a bit of a buzz and keep down my reaction times.”

It is difficult to feel sympathy for such moronic behaviour. Red Bull is a useless and unnecessary product which has been successfully marketed for idiots. While I’m on this topic how about …

Cold medicines

The US Food and Drug Administration (FDA) commissioned some outside experts to advise on medicines used by parents to treat their children’s coughs and colds. The conclusion was that products such as cough suppressants do not work and may cause side effects in young children. I recall that Consumer has reported on these products and the evidence is that they are not worth the money. This is the familiar placebo effect at work.

Hokum Locum

Debunking debriefing

It has become a cliché 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.