Scientology recently offered $12 million to FACTNet, an Internet library providing information on the dangers of mind control and cults, including information critical of Scientology. FACTNet’s directors turned down Scientology’s proposal, because it contained terms they considered unacceptable.Continue reading
THIS TRICENTENNIAL OBSERVANCE of the Massachusetts Day of Contrition cannot fail to provoke sombre and resolute thoughts in everyone who sees a parallel between the judicial horrors of the 1690s and those of the 1980s and 90s. Although Salem has a positive resonance for those who love American literature, the town inevitably calls to mind the aura of demented legalism that made the execution of so-called witches appear to be the only available course of action in 1692. Salem’s own Nathaniel Hawthorne, for one, could not escape that theme, and it helped colour his imagination and make him a lifelong brooder about irreparable wrongs.Continue reading
Folie-a-deux can be defined as a paranoid disorder in which the same delusion is shared by two (or more) persons. The delusion is thought to be transmitted from a dominant but paranoid person to his or her dependent intimate(s), and the latter may recover “normal” reality testing after separation from the former.
To my mind the interesting essential of this situation is that the sharing of a belief bonds and comforts its adherents; this feature may be obvious even where the belief is shared by many and would not ordinarily be regarded as delusional. For example, picture a church congregation reciting its creed in unison.
The Comfort of Shared Belief
What is the nature of the comfort so provided? In our prototypical, pathological case, where the belief is a persecutory delusion, the acceptance of the belief by a “significant other” signifies to “the beleaguered one” that he has found an ally or a protector; contrariwise, skepticism creates the kind of anxiety that would be felt by a small child who hears a robber entering his bedroom, but can’t convince a nearby parent to come to the rescue.
The delusional belief can thus function as a probe with which to test the love, loyalty and ready courage of the other. Where the belief is less persecutory (e.g., belief in God), the sharing of it is at least friendly, like sharing a meal; and the belief may seem to be validated by the numbers subscribing to it.
In either case, if a newcomer to the “church” demands evidence, he either misses the symbolic point, or is being deliberately obtuse and distinctly unfriendly. Those of us who are skeptics at heart will hesitate at the church door, having in the past experienced conflict between that social pressure and its opposite, a desire to be the maverick whose superior science will expose the error of the herd.
Or, if we were doctors, thought we had joined another sort of church, whose members sing in unison, credo in unum deum, Reality; and otherwise have to agree only on the means for finding it (the scientific method).
As doctors, we still take a great deal on trust in our human relationship with patients, and find warmth in that relationship that is cemented, without our consciously considering it, by mutual and traditional assumptions (for example about the nature of the roles each is to play). Generally, we assume the patient is trying to be honest, and certainly don’t demand proof for every detail of the history.
By being credulous in that way, we become the parent who will keep the robber, Death, at bay. Sometimes we come running even when we think the robber is imaginary. And after all, how can one be sure? In a case of suspected child abuse, better to call Social Services after a minimal reality check. “Time may be of the essence.” “Better to be safe than sorry.”
Yet there are many situations in which the credulous posture becomes problematic. The simplest of these is when the patient has been identified as “delusional”, which means that the doctor has decided in her heart that she does not believe, does not stand on common ground with her patient in regard to the delusional idea and does not wish to.
In the interests of the alliance, or out of empathy, she may still search for the grain of truth on which they can agree. Might she even disguise her belief for strategic purposes? Perhaps, after all, her patient is repeating in this doctor-patient relationship a childhood experience of being unable to summon a parent in the moment of terror.
Believing the Fantastic: The Problem
An especially muddled situation depending on credulity in the therapist-patient alliance has been the proliferation in recent years of therapies for victims of fantastic post-traumatic syndromes.
For example hypnotherapies for people who have been contacted, abducted or violated by extraterrestrials, or who have suffered trauma in a previous existence. I assume the reader shares my automatic scepticism regarding these trauma and their treatments. In any case, do we need to concern ourselves with this phenomenon beyond perhaps noting it as an interesting example of folie-a-deux?
But if such is their church, and it comforts them, why not leave them to it? Are not all the communicants consenting adults? The phenomenon is spreading. Abduction stories are becoming epidemic and are gaining more credibility in the media.
Another example, which has been closer to home for psychiatry, is the “growth industry” of treatments and conferences pertaining to multiple personality disorder and Satanic ritual abuse.
I say “closer to home” because, according to the sociologist Jeffrey S. Victor, fifty psychiatrists (and two hundred other professionals) attended the conference on ritual abuse he describes in his article, and two-thirds of the audience at one lecture raised their hands when asked if they had treated Satanic ritual abuse. Most seemed to assume that the survivor stories were literally true and that often such abuse had been the etiology of a multiple personality disorder in the surviving adult.
Admittedly such a conference will concentrate believers, but in my everyday work for a large health plan I too have had occasion to discuss Satanic ritual abuse with credulous therapists and to interview patients who presented typical survivor stories.
The contents of a typical ritual abuse story by now are familiar to many readers: perverse sexual activities occurred at length, repeatedly over the years, between Satanic perpetrators and the child protagonist, embellished with black robes and candles and laboured misuse of Christian symbols; the child was forced to take an active role in the murder of another child; blood was drunk or babies were dismembered and eaten; babies were being bred by the cult for the purpose of ritual sacrifice. Satan himself might appear on the scene.
In day-care cases, the lack of disinterested witnesses is explained by improbable transportation of children to a hidden site (by plane, by tunnels etc.), reminiscent of the “night flight” aspect of witchcraft hysteria. Enthusiasts for the theory hold that such abuse is widespread, for example that fifty thousand ritual sacrifices occur yearly, or that Satanic cults comprise a world-wide multi-generational conspiracy.
According to Kenneth Lanning, in charge of an FBI unit investigating Satanic cult crimes, “We now have hundreds of victims alleging that thousands of offenders are murdering tens of thousands of people, and there is little or no corroborative evidence, from a law-enforcement perspective”.
As therapists, should we care one way or the other about corroborative evidence? Is it not in the nature of an empathic therapeutic alliance to enter into the spirit of the patient’s experience? Is it not in the nature of the therapeutic process to deal evenhandedly with material drawn from fantasy and reality alike? And when it seems that numbers of professionals are unduly impressed by such stories, perhaps it is only their empathy at work; instinctively recognising that there is no better way of forging an alliance with the patient than to endorse the patient’s view of reality.
Yet, I am concerned that in pursuing this course, the therapist can lose track of how much sacrifice of her own intellectual autonomy is being made on behalf of the therapeutic relationship. Taken to an extreme, this kind of empathy ultimately places the therapist in the position of the dependent partner in a folie-a-deux.
There are other possible formulations of the problem I am addressing. Some ritual-abuse patients may be diagnostically closer to having a factitious disorder than to having paranoia, in which case the involved therapists might be regarded as the susceptible targets of a fraud. For example, I interviewed one patient who had obtained disability income on the basis of her post-Satanic multiple-personality disorder, while working with a therapist who had accepted this history without corroboration.
In the case of an adult who identifies cryptic signs of ritual abuse in a child and then applies for treatment or legal action, I see a parallel with the parent enacting a Munchhausen-by-proxy (in which the child is presented for treatment of an odd physical illness which has been fabricated or induced by the parent). In both cases, the parent usually appears especially devoted and concerned for the welfare of her child and compels the admiration of physicians and others involved, until the true situation is uncovered.
What factors beside empathy may have paralysed our capacity to doubt?
We all realise the harm that can result from not taking a sexual abuse story seriously, particularly when it comes from a child. We now practice in a state of heightened vigilance to prevent such abuse, interrupt it, or treat its post-traumatic stress disorder. We bend over backwards to correct Freud’s under-estimate of the true incidence of incest.
As a result, many of us have come to feel embarrassed to question any aspect of any story involving sexual abuse, no matter how truly fantastic. Even in the privacy of our own minds, it can seem that belief is obligatory. And when it comes to voicing doubts out loud, we anticipate a consensus to the contrary, or arguments ad hominem that charge our scepticism to our squeamishness, denial or insensitivity.
And here let me make a personal value explicit: that belief ideally rests on evidence that convinces, and that scepticism is a healthy, or at very least, a permissible first response to someone else’s novel hypothesis, especially when that hypothesis involves the supernatural or challenges common sense.
A third formulation to explain therapist credulity is favoured by Jeffrey Victor and other sceptical sociologists. They suggest that the Satanic ritual abuse phenomenon is an example of mass hysteria (a.k.a. moral panic), in which therapists, patients, clergymen, police and others become involved according to individual vulnerability and social context. They support this theory by an analysis of the manner in which the Satanic cult rumours are spread, and by amassing the cases in which no evidence could ever be found to demonstrate a reality behind the rumour.
The content of ritual-abuse stories also lends support to this explanation. For example, some women who seek “deprogramming” claim to have been practicing witches under the domination of Satan. Their scenario of an indulgence followed by repudiation is an exact duplication of that sequence in the behaviour of the children at the core of the seventeenth century witchcraft hysteria in Salem Village in Massachusetts. Beliefs about blood-drinking, baby-sacrifice, perverse intercourse with demons etc were also all represented in such earlier hysterias.
In the three hundred years of European witchcraft hysteria, ending not long after the Salem outbreak, 200,000 innocent men and women were murdered as witches. The hysteria was supported by the establishment, partly because the estates of wealthy “witches” could be confiscated by the court after they had been executed.
It is hard to imagine that three hundred years later, there is any danger of the whole social structure becoming caught up in teh hysteria in the way that it was in those times. It is alarming that part of the contemporary legend is a belief that individual modern cults are part of an ancient conspiracy, whose goal is to “create international chaos in order to allow Satan to take over the world.”
While believers in this theory may never succeed in creating the kind of panic that leads to sanctioned executions, “an unjustified crusade against those perceived as satanists could result in wasted resources, unwarranted damage to reputations, and disruption of civil liberties,” as Kenneth Lanning wrote in 1990. It has happened. Thousands of families in the United States have been needlessly disrupted, even if one can speculate that in some cases distancing the family might have been part of the patient’s agenda.
Causes of Mass Hysteria
The phrase “mass hysteria” describes a social phenomenon not necessarily restricted to people who individually suffer from histrionic or paranoid disorders. Other factors thought to contribute to vulnerability include gender (more often female) and pre-existing social ties. In the case of the Satanic cult hysteria, the “pre-existing social ties” exist within certain sub-groups of the mental-health professional communities. And the law-enforcement contingent at the seminars shares a fundamentalist Christian perspective:
“The most notable circular among cult-crime investigators, File 18 Newsletter, follows a Christian world-view in which police officers who claim to separate their religious views from their professional duties nevertheless maintain that salvation through Jesus Christ is the only sure antidote to Satanic involvement, whether criminal or noncriminal, and point out that no police officer can honourably and properly do his or her duty without reference to Christian standards.”
Many of the participating therapists also share this context.
Modern “local panics” about satanic cults “have almost all occurred in economically declining small towns and rural areas of the country”. Similarly, an analysis of the economic and political factors favouring hysteria can be made on the basis of the location on the Salem map, in 1692, of the homes of the accusers, the accused and their defenders.
It is interesting to speculate about other social causes of such hysteria. One possibility is that many people are interpreting the AIDS epidemic as God’s punishment for sexual wrongdoing, especially as it occurred concurrently with increasing public awareness of the reality of incest. A subgroup of these people may have been conditioned, by religious upbringing or personal history, to deal with anxiety about forbidden impulses through projection and splitting, and the real existence of Satanic cults provided the seed crystal for a conspiracy theory.
Similarly to a conversion symptom, the hysteria also provides the opportunity for disguised expression of sexual and aggressive interests, as the participants can discuss the details of abductions and orgies while claiming to be traumatised or outraged.
Relationship to Real Sexual Abuse
This brings me to the question of just what relationship the Satanic ritual-abuse hysteria bears to real instances of physical and sexual child abuse.
Obviously it can be viewed as a simple imitation of a true abuse situation, which appears cruder or gaudier than the original, as natural imitations generally do. Like the larger and more brightly spotted eggs of the cuckoo, the ritual-abuse story is a winner in the contest for nurturing behaviour.
In some cases, professionals involved in the hysteria have had personal knowledge of real cases of child pornography, incest, physical abuse, neglect, or those rare instances where the sexual molestation of a child was associated with Satanic embellishments (such perhaps was the case of Frank and Iliana Fuster, described by Roland Summit and others). Their subsequent participation in mass hysteria could be viewed as a manifestation of professional shell-shock.
In the New York Times of March 3, 1991, there was a description of a case in which a couple abandoned an infant to death by starvation because of their participation in an extended crack orgy. Three years ago I was involved in a similar case (the mother had been my patient). When her crime was discovered, incredulous friends attributed it to her having been kidnapped by a Satanic cult, which forced her to kill her baby.
This colourful explanation eased vicarious guilt (mine included, at the moments I was tempted to believe it) and extracted a drop of pleasurable drama from what was, in stark reality, an unmitigated horror.
The Satanic ritual-abuse hysteria could well be, in part, the product of that amazing ability of the human mind to transmute pain into pleasure. If so, I can understand why its adherents would be tenacious. Supposing them to have had childhoods studded by such painful episodes, one can hardly begrudge them the soothing balm and spangly entertainment of hysteria; of fictionising and dramatising their trauma at the moment of its emergence into publicity. At one remove, I am doing something similar as I now write.
Let me look a little more closely, though, at the nature of the relief provided to the ritual-abuse patient. It could go like this: if Satan and all his minions ravished her or her child, she was really not to blame. Never mind if mental health professionals had been trying to tell her that for years; when it comes to ground-in guilt, nothing gets it out like a home-made remedy.
How can it hurt to let the patient go on feeling that we validate this version of her story? In some cases that might seem the best course, or is the only alliance the patient will allow. But leaving aside the potential division of a family, within the patient herself, the split is left unhealed. Somewhere deep in her heart, she could still be wondering whether Satan, penis and all, is not a piece of herself, torn like Adam from her own chest.
And to get at that question, she will have to tell the real story — more homely, sad, or embarrassing. It might be a real incest story, but more likely it will be the story of a puritanical childhood, which — as in Marion Starkey’s Salem — allowed exitement only via tales of sin and punishment.
And what of the patients who, though now in no great distress, instinctively exploit a mass hysteria? What treatment will divert them from a life of disability under a factitious personality disorder or post-Satanic stress syndrome?
Thigpen and Cleckley, the authors of The Three Faces of Eve, believe that full-blown multiple-personality is extremely rare. Most patients seeking the diagnosis are histrionic personalities with a capacity for some dissociation, and a desire to promote that capacity “to … gain attention, or maintain an acceptable self-image, or accrue financial gain, or even escape responsibility for actions.” Multiple personality is almost unknown in England, where sensational biographical accounts of such patients are less available.
Fahy et al suggest treating multiple personality and lesser degrees of dissociation as symptoms of personality disorder. “It is our contention that sanctioning the dissociative behaviour, by concentrating on symptoms or encouraging symptomatic behaviour, may lead to reinforcement and entrenchment of the relevant symptom.” (The same argument applies to preoccupation with the ritual-abuse story.)
In a personal communication, Bessel VanDerKolk reframed the “attention-getting” motive I have here attributed to the multiple-personality or ritual-abuse patient. He takes a therapist’s sense that a patient is exhibiting or “getting off on trauma”, to be a marker for the presence of narcissistic issues in that patient, such as would derive from a childhood that was lacking the minimum essential mirroring from the parents. The resulting hunger to feel important to someone is appropriately gratified by an outraged therapist, even if the trauma is mislabelled by both therapist and patient.
There is a lively dialogue on the subject of therapist scepticism regarding multiple personality in The Journal of Nervous and Mental Disease. I wonder if professionals polarise over endorsing this diagnosis because of personal values regarding responsibility vs. dependency.
Physicians tend to be responsible, counterdependent stoics; as such we face a continual choice between envying the apparent ability of the dissociative patient to escape accountability, or merging with this patient in order to enjoy vicariously the gratifications he seems to achieve in that way. It is possible to shift between the two positions, but most will have a tendency toward one or the other.
Iatrogenic Contributions to Mass Hysteria
We must finally confront the fourth, and least palatable form in which therapist particiption has contributed to mass hysteria: case-finding therapists have been playing a role analogous to the witch-finders of earlier hysterias.
Of course then, the witches were not so much found as created, often by quite deliberate fraud with an obvious profit motive; I had presumed the therapist motivation to be more complicated, including for example the understandable pleasure of sharing the limelight falling on such a case.
An article on Satanic ritual abuse in the April, 1992 issue of The Psychiatric Times describes a case of a therapist who allegedly pressured her patient into telling the ritual abuse story. The patient explained, “It was never just enough to tell her that my grandmother had abused and tortured me. It always needed to be worse.”
This was a harbinger of the flood of false-memory retractions now appearing in the United States. Such zealous therapists would be the dominant partners of the folies-a-deux, the parents in a Munchausen-by-proxy, and the driving force behind hysteria. The past year’s work of the False Memory Syndrome Foundation would suggest that numbers of recanting accusers feel they had been pressured by their therapists in just this way.
The profit motive must now be taken more seriously. It is not necessarily unethical to pursue a specialty which meets the need of fashion, even if one does so with the covert through, “there’s money to be made from this”. Consider for example a hypnotist who decides that because of new anti-smoking laws, a smoking-cessation practice is likely to succeed. It is perfectly possible that he is sincere and zealous about this practice which also happens to be profitable. Yet, if somehow it turned out that hypnotism were more harmful than cigarettes, we would begin to wonder just how long the practitioner might have secretly stilled the doubts now shared by all.
Education or Tolerance?
It will not be possible to eradicate this type of mass hysteria, which has such a strong appeal and is so nearly adaptive for so many. Indeed, a fifth and final reframe for the phenomenon was suggested to me by the anthropologist Sherrill Mulhern (director of the Laboratoire des Rumeurs, des Mythes du Futur et des Sectes at the University of Paris). She believes that the satanic-abuse survivors and their convert therapists comprise an American possession cult.
Labeling mass hysteria in this way, reminds us of the adaptive and comforting aspects of religion, and blames no one (not parent, nor patient, nor therapist) for a phenomenon that springs from some widespread cultural source.
Yet (along with Ms. Mulhern) I remain concerned about the dangerous and counter-therapeutic aspects of cultic religions, in which vulnerable individuals may feel too much pressure to conform and to renounce family ties that might still have been a net positive resource.
And I feel bewildered to walk into my scientific church and find a significant portion of the congregation busily sacrificing a scapegoat on the altar.
Part of our role as doctors is to educate. We can make an effort to enlighten those of our colleagues who are treating factitious and conversion disorders without recognising them as such, and to come to the aid of those who sense the symptomatic nature of the story-telling but are confused as to what “empathy” requires in that situation.
Empathy need not disable the therapist’s observing ego, nor its faculty of critical thought. That is what generates the full list of diagnostic hypotheses and assesses the quality of the evidence available for choosing between them, so our empathy will be attuned to the real source of pain in a particular patient.
Institutionally, we can make more conscious choices about limiting clinical resources such as hospitalisations, especially where the relevant symptom is fully ego-syntonic or factitious. And finally, I think we need to examine the role played by ritual-abuse conferences, courses or therapies in feeding hysteria or proselytising for a new religion.
Sickness and Psychogenic Illness
The Canterbury ME (chronic fatigue syndrome, or CFS) are up in arms over proposed tighter controls on patients receiving both invalid and sickness benefits. CFS patients want funding for “residential detoxification services and “subsidies on natural remedies”. CFS is a classical psychogenic illness and as such it is quite improper for any affected patient to be on any long-term benefit on their own terms. Because of self-denial these patients resist any sensible suggestions on treatment and end up chronically unwell in a fulfilment of Abraham Lincoln’s statement that “most folks are as happy as they make up their mind to be.”
I managed to persuade such a patient to take anti-depressants and the improvement in well-being was amazing. This same person had paid to have all amalgam dental fillings removed and replaced with a predictable lack of improvement. A characteristic of CFS is the almost fanatical belief of the patients that their “illness” has a physical cause. Here is a report from a clinical psychologist about such a patient: “He scored nought on the depression inventory and three on the anxiety inventory. This is a person who does not wish to reveal anything about himself. During the interview he made it clear that he sees his problem in terms of recovery from a physical illness with no concomitant psychological manifestation.”
This fanatical belief in a physical cause of ME is also shared by many doctors whose therapeutic contact with their patients becomes a classic folie a deux.
Cultural variations were found in a WHO study which looked at depression worldwide. Only 5% of patients who were depressed said that they had psychological problems. Such a level of denial is compounded by the useless treatments offered by doctors. For example, antidepressants were prescribed for anxiety as often as for depression. Japan had a low incidence of depression due to the Japanese concept of jibyo signifying a mild chronic illness which a person carries through life and is not considered serious.
It should be mandatory for all patients with a diagnosis of CFS to undergo assessment by a Mental Health team. No person with CFS should be entitled to any long-term benefit unless they have had at least a six month trial of anti-depressant therapy. (Christchurch Press 18/7/95 New Scientist 25/3/95 p10)
Multiple Personality Disorder
This is a typically loony belief of New Age psychiatrists and it has received widespread acceptance in the US. This is hardly surprising in a culture where thousands of people believe that they have been abducted by aliens. Even such an august institution as Harvard Medical School has a psychiatrist who believes that extraterrestrial beings have visited this planet and abducted Earthlings! Striking a blow for academic freedom, the Dean of the Medical School “reaffirmed Dr Mack’s freedom to study what he wishes and to state his opinions without impediment.” In contrast, the British specialists have condemned the idea in scathing terms. Imagine the convenience of being able to blame an alternative personality for some misfortune such as a criminal offence. This absurd concept of MPD fits in to the prevailing “victim” philosophy of life whose adherents view themselves as being subject to forces beyond their control. (New Scientist 17 June 95, GP Weekly 23/8/95)
Continuing OOS Delusions
The occupational health professionals continue to indulge themselves over OOS. ACC is reported as being concerned about the vague nature of OOS and the fact that claims cannot be satisfactorily proved or disproved. Claims against ACC reached $4 million in the year ended 30 June 1994 and are increasing. The huge army of consultants advising on posture are doing just that — posturing.
At least I managed to get my contrary view published in Safeguard. Bernard Howard also sent me a newspaper cutting of a story concerning a musician allegedly suffering from OOS. I will quote his remarks which need no further comment: “After centuries of playing their instruments for hours per day, every day, musicians are only now developing OOS. Come back Paganini…all’s forgiven!” (Safeguard Update Nos 26, 27 1995.)
15,000 French doctors practise acupuncture and many also use “high-dilution” homeopathic medicines. It is not surprising then that a hospital dedicated to traditional Chinese medicine will open in Paris next year under the joint sponsorship of the Chinese and French Ministries of health. It is promoted as a measure to control spiralling health costs.
This trendy quackery will help the “worried well” but will do nothing to control spiralling health costs which are a feature of unreasonable patient expectation and over-application of medical technology. (British Medical Journal Vol 310 p1285)
Uncontrolled Medical Appetites
Magnetic resonance imaging (MRI) is a radiological technique which is valuable for examining internal organs. In NZ Doctor, an American doctor outlines what he calls MRI madness. Americans are so obsessed with MRI technology that there are 25 times as many machines in California as in Canada, which has about the same population. Patients demand MRI scans for virtually any medical condition and as a third party (ie. insurance company) is paying, they get what they want.
Just about everyone with low back pain gets an MRI scan. However, a new study found that two out of three people without back pain have evidence of a disc protrusion. The authors concluded that anatomical abnormalities are common in normal people.
A skeptical US doctor described the obsession with MRI as “MRI tiger balm”. (GP Weekly 27/7/94, NZ Doctor 23/6/95)
A Reader Writes
In Skeptic 36 I asked how long before magic mushrooms (Kombucha) arrived in New Zealand. John Turner has written from Motueka to tell me that they are here! [See also Forum] I hope I am not compromising his continued existence in Golden Bay by passing on his description of the area as being a “bloated gelatinous pancake of new Ageism.” As John describes it: “the ‘mushroom’ has a baby which is then passed on to someone else.”
One convert claimed he was cured of “toxins” which coloured his urine brown as they left his body. John quite reasonably enquired as to what colour the mushroom brew was. It was brown! Those readers contemplating a visit to Golden Bay will be pleased to know that every quack treatment is available from holistic pulsing to sound healing with “yidaki” or as it is more commonly known, didgeridoo therapy. This may all sound like a lot of didgeridoodoo but in the US a woman died and another was hospitalised due to severe acidosis after drinking Kombucha tea. (John Turner (personal communication), Nelson Evening Mail 8/7/95, NCAHF Vol 18 No.3)
I recently complained to the Medical Practioners Disciplinary Committee (MPDC) about a doctor who made a series of ignorant and unproven claims in respect of immunisation. The MPDC is fairly toothless when it comes to dealing with scientific incompetence in medical practitioners and the unrepentant doctor even wrote me a letter declaring he was proud to be a member of the American Quack Association (Quack = Quality, Care and Kindness). I will quote a short passage to show how impossible it is to argue with such people.
I challenged his claim that Vitamin C is an effective treatment for viral diseases (7 placebo controlled trials showed lack of effect for Vit C in the treatment of cold virus infections). Here is his reply: “There is extensive peer-reviewed literature bearing witness to the clinical effectiveness of ascorbic acid in viral diseases. You will not find reference to this in Medline or Index Medicus journals that represent only about 10% of the world’s scientific journals and are controlled by the international pharmaceutical industry.”
This one paragraph contains two of the main quack elements. Firstly the suggestion that some alternative inferior data base is an acceptable alternative to controlled trials, and secondly the familiar old conspiracy bogey that scientific journals are controlled by vested interests.
The President of the Australian Medical Association has come out a lot more strongly than the NZ MPDC, by recommending that doctors who use their scientific standing in the community to support the anti-immunisation movement should be charged with medical negligence. At the time he made this remark Australia came near the bottom of a list of industrialised nations when rates of childhood immunisations were compared.
It is sad that at time of writing Russia is in the grip of an epidemic of diptheria which has killed more than 2000 people. This was a direct result of allowing immunisation levels to drop below the 95% required to prevent epidemics. (Dr Quack (personal communication), British Medical Journal Vol 310, p760. Lancet Vol 345 p715)
Evidence Based Medicine
Although my main interest is alternative medical quackery there are many traditionally accepted medical practices which have never been critically evaluated. I mentioned counselling in Skeptic 36 and this was enlarged on by Jim Ring in the last issue.
In Britain, the BMJ is sponsoring a Journal of Evidence-Based Medicine which is aimed at critically evaluating both new and old treatments. The key element is randomised controlled trials (RCT’s) in which patients must be randomly allocated to either a new treatment group or a control group (may be the existing treatment or no treatment). A survey of RCT’s in pregnancy and childbirth found that out of 100 procedures commonly carried out by obstetricians and midwives, about 20 are actually harmful.
If you go to your doctor complaining of a cough, the chances are that you will come away with a prescription for an antibiotic. This is despite the fact that seven RCT’s have shown no benefit for such treatment. It was also difficult to carry out the trials because in one survey 60% of eligible patients refused to enter a trial because they felt that antibiotics were absolutely necessary to cure their condition. Perhaps this is a good argument for using harmless placebos in such cases? I should mention a note of caution against blindly imposing the results of RCT’s on patients and this point was well expounded by Sir John Scott at our last conference. What will it take to stop physicians from prescribing antibiotics in acute bronchitis? (Lancet Vol 345 p665)
Aminophylline-containing cream is a popular quack remedy for reducing the size of large thighs. In a test, researchers studied women who were asked to massage either the cream or a placebo into one thigh and one side of the stomach. 11 out of the 17 women completed the study and, as anyone could have predicted, there was no fat-reducing effect. Despite measurements to the contrary, one woman was convinced that the cream worked. If it is important for people to believe in something, no amount of evidence to the contrary will convince them. (National Council Against Health Fraud (NCAHF) Vol 18 N0.3)
Civic Creche Case
Professor Michael Hill examined some of the issues behind the civic creche case in an article in the Christchurch Press 31/3/95 which I have forwarded to our editor. Hill coins the phrase “culture of complaint” in which disaffected people take little responsibility for their own lives and look instead for someone to blame. The existence of compensation through litigation completes this ‘Americanisation’ of our culture. It is incredible how quickly the false ideas behind ritual sexual abuse spread and were recreated throughout NZ.
I was disgusted with the judiciary over the civic creche case although the whole process was hijacked by the usual cohort of poorly trained quack therapists. The prosecution was able to get away with not presenting evidential material so ridiculous that it would have weakened their case. In a trial of any kind all the evidence should be available to both sides. My heart goes out to the falsely accused women whose lives have been ruined by this evil nonsense. I seriously question whether there was any chance at all of Peter Ellis getting a fair trial in an atmosphere of hysteria reminiscent of the Salem witch hunts.
A group of scientists have petitioned the FDA to place tighter restrictions on homeopathic remedies by making them reach the same standards of safety and effectiveness as other OTC drugs. There should not be any problem over safety since such remedies are the pharmacological version of the emperor’s new clothes. The drug exists in the imagination only.
Predictably there has been opposition from the National Centre for Homeopathy because “homeopathy doesn’t treat diseases but treats people who are ill.” The NCH wants a different type of evaluation. This is rather like admitting that homeopathy is scientifically inexplicable so a new science must be created to explain it.
This is a Feynman Commencement Address given by Richard Feynman at Caltech in 1974. This message is as relevant today as it was 20 years ago, especially for those who add their committed “science” to the cause of apocalyptic environmentalism.
During the Middle Ages there were all kinds of crazy ideas, such as that a piece of rhinoceros horn would increase potency. Then a method was discovered for separating the ideas — which was to try one to see if it worked, and if it didn’t work, to eliminate it. This method became organised, of course, into science. And it developed very well, so that we are now in the scientific age. It is such a scientific age, in fact, that we have difficulty in understanding how witch doctors could ever have existed, when nothing that they proposed ever really worked — or very little of it did.
But even today I meet lots of people who sooner or later get me into a conversation about UFOs, or astrology, or some form of mysticism, expanded consciousness, new types of awareness, ESP, and so forth. And I’ve concluded that it’s not a scientific world.
Most people believe so many wonderful things that I decided to investigate why they did. And what has been referred to as my curiosity for investigation has landed me in a difficulty where I found so much junk that I’m overwhelmed. First I started out by investigating various ideas of mysticism, and mystic experiences. I went into isolation tanks and got many hours of hallucinations, so I know something about that. Then I went to Esalen, which is a hotbed of this kind of thought (it’s a wonderful place; you should go visit there). Then I became overwhelmed. I didn’t realise how much there was.
At Esalen there are some large baths fed by hot springs situated on a ledge about thirty feet above the ocean. One of my most pleasurable experiences has been to sit in one of those baths and watch the waves crashing onto the rocky shore below, to gaze into the clear blue sky above, and to study a beautiful nude as she quietly appears and settles into the bath with me.
One time I sat down in a bath where there was a beautiful girl sitting with a guy who didn’t seem to know her. Right away I began thinking, “Gee! How am I gonna get started talking to” this beautiful nude babe?”
I’m trying to figure out what to say, when the guy says to her, “I’m, uh, studying massage. Could I practice on you?”
“Sure”, she says. They get out of the bath and she lies down on a massage table nearby.
I think to myself, “What a nifty line! I can never think of anything like that!” He starts to rub her big toe. “I think I feel it”, he says. “I feel a kind of dent — is that the pituitary?”
I blurt out, “You’re a helluva long way from the pituitary, man!”
They looked at me, horrified — I had blown my cover — and said, “It’s reflexology!”
I quickly closed my eyes and appeared to be meditating.
That’s just an example of the kind of things that overwhelm me. I also looked into extrasensory perception and PSI phenomena, and the latest craze there was Uri Geller, a man who is supposed to be able to bend keys by rubbing them with his finger. So I went to his hotel room, on his invitation, to see a demonstration of both mind-reading and bending keys.
He didn’t do any mind-reading that succeeded; nobody can read my mind, I guess. And my boy held a key and Geller rubbed it, and nothing happened. Then he told us it works better under water, and so you can picture all of us standing in the bathroom with the water turned on and the key under it, and him rubbing the key with his finger. Nothing happened. So I was unable to investigate that phenomenon.
But then I began to think, what else is there that we believe? (And I thought then about the witch doctors, and how easy it would have been to check on them by noticing that nothing really worked.) So I found things that even our own people believe, such as that we have some knowledge of how to educate.
There are big schools of reading methods and mathematics methods, and so forth, but if you notice, you’ll see the reading scores keep going down — or hardly going up in spite of the fact that we continually use these same people to improve the methods. There’s a witch doctor remedy that doesn’t work. It ought to be looked into; how do they know that their method should work? Another example is how to treat criminals. We obviously have made no progress — lots of theory, but no progress — in decreasing the amount of crime by the method that we use to handle criminals.
Yet these things are said to be scientific. We study them. And I think ordinary people with common sense ideas are intimidated by this pseudoscience. A teacher who has some good idea of how to teach her children to read is forced by the school system to do it some other way — or is even fooled by the school system into thinking that her method is not necessarily a good one. Or a parent of bad boys, after disciplining them in one way or another, feels guilty for the rest of her life because she didn’t do “the right thing”, according to the experts.
So we really ought to look into theories that don’t work, and science that isn’t science.
I think the educational and psychological studies I mentioned are examples of what I would like to call “cargo cult science”.
In the South Seas there is a cargo cult of people. During the war they saw airplanes land with lots of good materials, and they want the same thing to happen now. So they’ve arranged to make things like runways, to put fires along the sides of the runways, to make a wooden hut for a man to sit in, with two wooden pieces on his head like headphones and bars of bamboo sticking out like antennas — he’s the controller — and they wait for the airplanes to land. They’re doing everything right. The form is perfect. It looks exactly the way it looked before. But it doesn’t work. No airplanes land. So I call these things cargo cult science, because they follow all the apparent precepts and forms of scientific investigation, but they’re missing something essential, because the planes don’t land.
Now it behooves me, of course, to tell you what they’re missing. But it would be just about as difficult to explain to the South Sea Islanders how they have to arrange things so that they get some wealth in their system. It is not something simple like telling them how to improve the shapes of the earphones. But there is one feature I notice that is generally missing in cargo cult science. That is the idea that we all hope you have learned in studying science in school — we never explicitly say what this is, but just hope that you catch on by all the examples of scientific investigation.
It is interesting, therefore, to bring it out now and speak of it explicitly. It’s a kind of scientific integrity, a principle of scientific thought that corresponds to a kind of utter honesty — a kind of leaning over backwards. For example, if you’re doing an experiment, you should report everything that you think might make it invalid — not only what you think is right about it: other causes that could possibly explain your results, and things you thought of that you’ve eliminated by some other experiment, and how they worked — to make sure the other fellow can tell they have been eliminated.
Details that could throw doubt on your interpretation must be given, if you know them. You must do the best you can — if you know anything at all wrong, or possibly wrong — to explain it. If you make a theory, for example, and advertise it, or put it out, then you must also put down all the facts that disagree with it, as well as those that agree with it.
There is also a more subtle problem. When you have put a lot of ideas together to make an elaborate theory, you want to make sure, when explaining what it fits, that those things it fits are not just the things that gave you the idea for the theory; but that the finished theory makes something else come out right, in addition.
In summary, the idea is to try to give all of the information to help others to judge the value of your contribution; not just the information that leads to judgement in one particular direction or another.
The easiest way to explain this idea is to contrast it, for example, with advertising. Last night I heard that Wesson oil doesn’t soak through food. Well, that’s true. It’s not dishonest; but the thing I’m talking about is not just a matter of not being dishonest, it’s a matter of scientific integrity, which is another level. The fact that should be added to that advertising statement is that no oils soak through food, if operated at a certain temperature. If operated at another temperature, they all will, including Wesson oil. So it’s the implication which has been conveyed, not the fact, which is true, and the difference is what we have to deal with.
We’ve learned from experience that the truth will come out. Other experimenters will repeat your experiment and find out whether you were wrong or right. Nature’s phenomena will agree or they’ll disagree with your theory. And, although you may gain some temporary fame and excitement, you will not gain a good reputation as a scientist if you haven’t tried to be very careful in this kind of work. And it’s this type of integrity, this kind of care not to fool yourself, that is missing to a large extent in much of the research in cargo cult science.
A great deal of their difficulty is, of course, the difficulty of the subject and the inapplicability of the scientific method to the subject. Nevertheless it should be remarked that this is not the only difficulty. That’s why the planes didn’t land — but they don’t land.
We have learned a lot from experience about how to handle some of the ways we fool ourselves.
One example: Millikan measured the charge on an electron by an experiment with falling oil drops, and got an answer which we now know not to be just right. It’s a little bit off, because he had the incorrect value for the viscosity of air. It’s interesting to look at the history of measurements of the charge of the electron, after Millikan. If you plot them as a function of time, you find that one is a little bigger than Millikan’s, and the next one’s a little bit bigger than that, and the next one’s a little bit bigger than that, until finally they settle down to a number which is higher.
Why didn’t they discover that the new number was higher right away? It’s a thing that scientists are ashamed of — this history — because it’s apparent that people did things like this: when they got a number that was too high above Millikan’s, they thought something must be wrong — and they would look for and find a reason why something might be wrong. When they got a number closer to Millikan’s value, they didn’t look so hard. And so they eliminated the numbers that were too far off, and did other things like that. We’ve learned those tricks nowadays, and now we don’t have that kind of a disease.
But this long history of learning how not to fool ourselves — of having utter scientific integrity — is, I’m sorry to say, something that we haven’t specifically included in any particular course that I know of. We just hope you’ve caught on by osmosis.
The first principle is that you must not fool yourself — and you are the easiest person to fool. So you have to be very careful about that. After you’ve not fooled yourself, it’s easy not to fool other scientists. You just have to be honest in a conventional way after that.
I would like to add something that’s not essential to the science, but something I kind of believe, which is that you should not fool the layman when you’re talking as a scientist. I am not trying to tell you what to do about cheating on your wife, or fooling your girlfriend, or something like that, when you’re not trying to be a scientist, but just trying to be an ordinary human being — we’ll leave those problems up to you and your rabbi.
I’m talking about a specific, extra type of integrity that is not lying, but bending over backwards to show how you’re maybe wrong, that you ought to have when acting as a scientist. And this is our responsibility as scientists, certainly to other scientists, and I think to laymen.
For example, I was a little surprised when I was talking to a friend who was going to go on the radio. He does work on cosmology and astronomy, and he wondered how he would explain what the applications of this work were.
“Well”, I said, “there aren’t any.” He said, “Yes, but then we won’t get support for more research of this kind.”
I think that’s kind of dishonest. If you’re representing yourself as a scientist, then you should explain to the layman what you’re doing — and if they don’t want to support you under those circumstances, then that’s their decision.
One example of the principle is this: if you’ve made up your mind to test a theory, or you want to explain some idea, you should always decide to publish it whichever way it comes out. If we only publish results of a certain kind, we can make the argument look good. We must publish both kinds of results.
I say that’s also important in giving certain types of government advice. Supposing a senator asked you for advice, about whether drilling a hole should be done in his state; and you decide it would be better in some other state. If you don’t publish such a result, it seems to me you’re not giving scientific advice. You’re being used. If your answer happens to come out in the direction the government or the politicians like, they can use it as an argument in their favour; if it comes out the other way, they don’t publish it at all. That’s not giving scientific advice.
Other kinds of errors are more characteristic of poor science. When I was at Cornell, I often talked to the people in the psychology department. One of the students told me she wanted to do an experiment that went something like this — it had been found by others that under certain circumstances, X, rats did something, A. She was curious as to whether, if she changed the circumstances to Y, they would still do A. So her proposal was to do the experiment under circumstances Y and see if they still did A.
I explained to her that it was necessary first to repeat in her laboratory the experiment of the other person — to do it under condition X to see if she could also get result A, and then change to Y and see if A changed. Then she would know that the real difference was the thing she thought she had under control.
She was very delighted with this new idea, and went to her professor. And his reply was, no, you cannot do that, because the experiment has already been done and you would be wasting time. This was still about 1947 or so, and it seems to have been the general policy then to not try to repeat psychological experiments, but only to change the conditions and see what happens.
Nowadays there’s a certain danger of the same thing happening, even in the famous field of physics. I was shocked to hear of an experiment done at the big accelerator at the National Accelerator Laboratory, where a person used deuterium. In order to compare his heavy hydrogen results to what might happen with light hydrogen he had to use data from someone else’s experiment on light hydrogen, which was done on different apparatus. When asked why, he said it was because he couldn’t get time on the program (because there’s so little time and it’s such expensive apparatus) to do the experiment with light hydrogen on this apparatus because there wouldn’t be any new result.
And so the men in charge of programs at NAL are so anxious for new results, in order to get more money to keep the thing going for public relations purposes, they are destroying — possibly — the value of the experiments themselves, which is the whole purpose of the thing. It is often hard for the experimenters there to complete their work as their scientific integrity demands.
Not all experiments in psychology are of this type, however. For example, there have been many experiments running rats through all kinds of mazes, and so on — with little clear result. But in 1937 a man named Young did a very interesting one. He had a long corridor with doors all along one side where the rats came in, and doors along the other side where the food was. He wanted to see if he could train the rats to go in at the third door down from wherever he started them off. No. The rats went immediately to the door where the food had been the time before.
The question was, how did the rats know, because the corridor was so beautifully built and so uniform, that this was the same door as before? Obviously there was something about the door that was different from the other doors.
So he painted the doors very carefully, arranging the textures on the faces of the doors exactly the same. Still the rats could tell. Then he thought maybe the rats were smelling the food, so he used chemicals to change the smell after each run. Still the rats could tell. Then he realised the rats might be able to tell by seeing the lights and the arrangement in the laboratory like any common sense person. So he covered the corridor, and still the rats could tell.
He finally found that they could tell by the way the floor sounded when they ran over it. And he could only fix that by putting his corridor in sand. So he covered one after another of all possible clues and finally was able to fool the rats so that they had to learn to go in the third door. If he relaxed any of his conditions, the rats could tell.
Now, from a scientific stand-point, that is an A-number-one experiment. That is the experiment that makes rat-running experiments sensible, because it uncovers the clues that the rat is really using — not what you think it’s using. And that is the experiment that tells exactly what conditions you have to use in order to be careful and control everything in an experiment with rat-running.
I looked into the subsequent history of this research. The next experiment, and the one after that, never referred to Mr Young. They never used any of his criteria of putting the corridor on sand, or being very careful. They just went right on running rats in the same old way, and paid no attention to the great discoveries of Mr Young, and his papers are not referred to, because he didn’t discover anything about the rats. In fact, he discovered all the things you have to do to discover something about rats. But not paying attention to experiments like that is a characteristic of cargo cult science.
Another example is the ESP experiments of Mr Rhine, and other people. As various people have made criticisms — and they themselves have made criticisms of their own experiments — they improve the techniques so that the effects are smaller and smaller and smaller until they gradually disappear. All the parapsychologists are looking for some experiment that can be repeated — that you can do again and get the same effect — statistically, even. They run a million rats — no, it’s people this time — they do a lot of things and get a certain statistical effect. Next time they try it they don’t get it any more. And now you find a man saying that it is an irrelevant demand to expect a repeatable experiment. This is science?
This man also speaks about a new institution, in a talk in which he was resigning as Director of the Institute of Parapsychology. And, in telling people what to do next, he says that one of the things they have to do is be sure they only train students who have shown their ability to get PSI results to an acceptable extent — not to waste their time on those ambitious and interested students who get only chance results. It is very dangerous to have such a policy in teaching — to teach students only how to get certain results, rather than how to do an experiment with scientific integrity.
So I have just one wish for you — the good luck to be somewhere where you are free to maintain the kind of integrity I have described, and where you do not feel forced by a need to maintain your position in the organisation, or financial support, or so on, to lose your integrity.
May you have that freedom.
The recent decision to award compensation to a lawyer who suffered depression because his bank loan was turned down is but one example of increasingly bizarre decisions by the ACC (Anything-goes Compensation Corporation). Money has also been paid out to victims for “memories” of childhood sexual abuse but in one recent case the alleged offender was aquitted and we are still waiting to see whether ACC will ask for their money back. (see Skeptic 34).
I obtained information about a court judgement involving ACC who awarded compensation to an employee of the Fire Service, one of a number of people affected by mass hysteria after the ICI Chemical Fire. Advising doctors said that his condition was not considered to be due to chemical exposure but his emotional state could be attributed to some stress surrounding attendance at the fire. The judge had no alternative under current law to do anything other than award full rights to compensation.
Not only do these decisions show a lack of common sense, they also illustrate what happens when no one is prepared to stand up and resist such claimants, who will continue to come forward as long as there is money available. This prevailing community belief that everyone is entitled to compensation for their “pain” whatever it is, is not limited to New Zealand. There is a worldwide growth in anti-medical science groups with self-denied psychiatric conditions. In the UK a sufferer from chronic fatigue syndrome (see Skeptic 21, 26) was awarded compensation because the stress of a car accident in which he received no physical injuries, made his symptoms worse!
Hoxsey Cancer Quackery
Bruno Lawrence recently went public with the fact that he is suffering from lung cancer and plans to make a TV documentary about his treatment at a Hoxsey Clinic in Mexico. About the same time, a syndicated article appeared in my local paper with the news that a Tauranga herbalist intended setting up such a clinic and applying to the local area health board for approval.
Hoxsey (1901-1973) developed a secret recipe of herbs and spices which he used to treat cancer patients. This followed an observation that a horse with cancer cured itself by grazing on certain plants. Hoxsey fought prolonged court battles with both the American Medical Association (AMA) and the FDA before taking his quack therapy to unregulated Mexico. He died from cancer despite self-treatment with his quack remedy.
His original nurse, Mildred Nelson, was still administering this quackery as recently as 1988. The American Cancer Society (ACS) has extensively investigated Hoxsey’s cancer quackery and I quote from the last paragraph of their report which I am happy to supply free to any reader as long as you send a stamped SAE: “In summary, the Hoxsey medicines for cancer have been extensively tested and found to be both useless and archaic. The ACS does not recommend their use by cancer patients.”
Quackery often follows a pattern as follows:
- An apparently profound observation or emotional experience — in Hoxsey’s case, a sick horse, and in the case of iridology certain patterns in the iris of a sick bird. Doctors often revert to quackery following either job stress or a seemingly profound success with a new treatment such as acupuncture, homeopathy etc. (usually a placebo response).
- An element of paranoia is useful, because this heightens the belief of the quack that the particular treatment is valuable and “everyone’s out to get me!” and leads to…
- Conspiracy theory. In the case of Hoxsey, he developed the theme that doctors and the AMA had cornered the cancer market (is there one?). This is a very useful strategy for discrediting conventional medicine.
- The quack remedy should be completely safe and quite expensive because patients will show improvement in proportion to money spent. Distilled water is cheaper and more convenient than homeopathic remedies and is already an accepted consumer fraud.
- Reliance solely on testimonials and strict avoidance of clinical trials or any form of testing of the quack remedy. Testimonials are personal, entertaining and are excellent advertising, unlike the prosaic clinical trial which will show that the quack remedy is for the ducks. If a clinical trial or, in the case of Milan Brych, a court case, proves quackery, then all is not lost. Off-shore operations will ensure patients keep on coming, which is what hundreds of people did even after Brych was shown to be a complete fraud and actually in prison at the time he claimed to be at medical school. (I can think of a few doctors I would like to see in prison but that’s another story.)
Finally, the above information is subject to intellectual property rights and I expect a commission from any readers who set up successful cancer quackery clinics.
An article in the BMJ (Vol 309 p883, “The dangers of good intentions”) caught my eye, as it is a devastating example of the psychopathology so evident in the helping professions. In 1939, 700 delinquents were randomly assigned to either a treatment group or a control group who received no treatment but were followed up 30 years later.
The treatment group received counselling, home help and other community assistance. After 30 years it was the treatment group who were sicker, drunker, poorer and more criminal! This shows that nothing can be taken for granted when trying to influence people’s behaviour, and often such programs create dependency. Our own welfare state is a classic illustration of this problem.
In Skeptic 33 I made a plea for hard data on the popular new condition of post-traumatic stress disorder (PTSD). Like any alleged medical condition it must be refutable, ie. capable of being proved wrong. A writer in the BMJ (Vol 309 p873) sharply criticised a case presentation on PTSD in a patient who was a heavy drinker. He pointed out that 40% of all patients diagnosed as having PTSD drink heavily and their symptoms (frightening ideas, nightmares) subside when they abstain. I am still cynically waiting to find out whether PTSD is described in populations which do not have compensation.
In Canada, a man was aquitted of stabbing to death his parents-in-law because a psychiatrist testified that the man was sleep-walking and therefore had not been responsible for his actions. The fact that the accused was also a gambler who had been caught embezzling money did not seem to be quite so important to the court!
Psychiatry as a specialty relies on rather soft science, and some psychiatrists are guilty of the most absurd psychobabble — eg, “Continuing success will reflect [the patient’s] ongoing committment to healing the wounded child within, which is the result of the experience of the poisonous pedagogy.”
Doctors’ signatures can certainly be very valuable. As far as patients are concerned, it means another ten paid weeks off work. Some 85,000 people have been collecting such benefits for more than one year and ACC is hoping to save $400 million by referring all cases to an independent medical panel.(GP Weekly, 22 Feb 95)
In the Australian Capital Territory (ACT) a new law allows people to use cannabis on a doctor’s prescription provided that the doctor keeps “research notes.” The ACT Health Minister described the new law as a “radical drug experiment”. I describe it as radical stupidity, as there is no evidence that cannabis is useful for the conditions proposed and I doubt the ability of individual GPs to conduct research. Here is my prediction: patients will flock to certain doctors who have found by research that their signature on a piece of paper is of considerable benefit to both the patient and the doctor’s bank manager. Buy ACT cannabis futures now! (GP Weekly, 22 Feb 95)
In the UK, a housing authority allowed preferential allocation for housing on receipt of a note from the doctor outling health reasons. However, they were able to revert to their normal process of allocation because everyone on the list had a note from their GP! All processes such as this become debased and degraded when subject to abuse.
Along with other legitimised quackery, the French government recognises a stay at a spa as a legitimate medical treatment. The National Audit Court pointed out that not only is there no proven scientific justification for spa treatment, but many carry bacterial health risks. Some spas have even been adding tap water to their natural mineral waters.
I seem to remember an investigation in New Zealand showing that certain “mineral waters” were indistinguishable from tap water. (New Scientist, 28 Jan 95)
Alternative Medical Remedies
The Medicines Act is being re-written, and already quacks are whining that the costs of licensing their remedies could force them off the market. Quacks also fear a ban on advertising that they can offer relief from various conditions. I don’t see any problem with the proposed law changes, as herbal remedies should come up to set standards of quality and safety and any claims of efficacy should be tested in randomised trials. (GP Weekly, 14/9/94)
After reading this I was intrigued to find a letter in the Lancet (Vol 344 p134) which looked at the ginseng composition of 50 commercial ginseng products. The authors found that 44 preparations ranged from 1.9% to 9.0% of ginsenosides, the active components. The remaining 6 preparations contained no ginsenosides at all. They also quoted a case of an athlete who failed a drug test. He thought he was only taking ginseng, but not only did his preparation not contain any ginseng, it consisted mainly of the banned performance-enhancing drug ephedrine.
Would anybody buy an aspirin that might contain either no aspirin at all or anywhere from 100mg to 500mg of the active drug? The authors conclude that “quality control is urgently needed for natural remedies with suspected or assumed biological activity.” I see a compelling case for continuing with a robust overhaul of our Medicines Act.
Face Lifts and Hair Growth
A Wellington plastic surgeon was critical of a recent proposal that GP’s could learn to do chemical face peels after watching a training video (Dominion, 15/9/94). GPs can buy a kit which contains enough chemicals and equipment to make a profit of $380 per patient for half an hour’s work. The process involves using glycolic acid to induce peeling and, by an unspecified process, cosmetic improvement. Just the thing for boosting the flagging profits of any North Shore Auckland medical practice where there are already so many doctors the place is in danger of turning into a ghetto.
I don’t intend watching the video, but the thought had crossed my mind that I could treat my vain patients in our RNZAF electroplating bay. A short dip in something caustic would give anyone’s face a good lift (off) or how about dermabrasion with a wire brush from the metal shop?
A much safer money-earning prospect is the exciting new treatment of electrotrichogenesis for bald men. I hope our editor can reproduce the advertisement which shows a futuristic looking chair with a hood poised to administer rejuvenating current to the recalcitrant scalp. [Unfortunately it’s a bit too dark to reproduce well — but it looks fascinating…]
Why not fill the waiting room with these chairs and invite balding males to pay for treatment while they wait to see the doctor on other matters. Even more doctors will be able to afford to go into practice on the North Shore!
Thanks to a member who was present, we now have a set of audiotapes which record the complete proceedings of the 1994 CSICOP Conference in Seattle, on The Psychology of Belief
Topics discussed include: Alien Abductions, Anomalies of Perception, Memory, CSICOP and the Law, Beliefs in the Courtroom, Conspiracy Theories.
Speakers include Paul Kurtz, Philip Klass, Susan Blackmore, John Maddox, Carl Sagan, Elizabeth Loftus and other illustrious Skeptics.
Members are invited to obtain a detailed list from the Secretary (Bernard Howard, 150 Dyers Pass Road, Christchurch), who is prepared to negotiate loans of individual tapes.
When the short list for the Booker prize was announced there was much chortling about the fact that Jill Paton Walsh had been unable to find a publisher in Britain for Knowledge of Angels. She had to publish it herself.
The Times Literary Supplement (9 Sep, 1994) points out that the English publishing houses could not justify their decision by claiming that they had a surplus of great and worthwhile books. Heinemann has just published what the TLS described as “a work of the purest bilge”. They refer to Nostradamus: his key to the centuries, prophecies of Britain and the world 1995-2010, by V.J. Hewitt.
This adventurous work is not Valerie Hewitt’s first appearance as a seer. In her earlier publication, Nostradamus: The end of the millenium, she predicted that George Bush would be re-elected in 1992, that the Prince of Wales would be crowned King Charles III on May 2 of the same year, and that California would be destroyed by an earthquake on 8 May 1993.
In spite of this unenviable track record, Valerie Hewitt seems to have no difficulty finding gullible publishers. Poetic justice could have won the day. Maybe they asked her, as Nostradamus’ UK agent, to pick the Booker Prize List as well.
An American Dilemma
In the September 16 issue of the Times Literary Supplement, Prof Claude Rawson made a nice point during his review of The Beginning of the Journey — the marriage of Diana and Lionel Trilling, by Diana Trilling. I’m sure the TLS won’t mind us quoting at length:
“[Diana] too persevered with analysis despite a series of discouraging experiences, including a date with her first psychiatrist, from which she had to be sent home by taxi in a drunken panic … Three of her analysts died on her, an occupational hazard in transactions not otherwise willingly terminated by either party. One was a drug addict who missed appointments and fell asleep during sessions … She was next treated by by Marianne Fris, wife of Ernst, who told her that Lionel was being mishandled by his analyst … At one point the Trillings shared the same analyst and became “sibling rivals, vying for the attention of the same father figure”
This (Stalinist) doctor turned out to be unqualified and had to be retrained. The next “analyst’s wife, herself a psychiatrist” maintained a courteous professional distance. When her husband fell under a car she demanded payment of bills already paid, maintaining professional behaviour to the end. Diana had seven analysts in all and still feels that she “was never properly analysed”.
You might think she was slow on the uptake, but the persistence with which busy and intelligent persons in the US lavish their time and money on analysis in the teeth of a continuous sense of the inefficacy of the whole thing is a cultural phenomenon that awaits explanation.
If you remain unconvinced, watch the wonderfully scary video called Whispers in the Dark. It’s hard to know who is the most terrifying — the psychiatrists or their patient/victims. (Not for children)
Science and the Citizen
On Tuesday 26 September, National Radio’s Morning Report carried an interview with a scientist discussing his research programme which I hope is better founded than it sounded — seeing that we are all paying for it.
Apparently some Danes have shown that males who eat organic food are more fertile than those who eat regular (inorganic?) food. Our local scientist plans to repeat the programme here because if they confirm the Danish findings, it will prove that — and wait for it — pesticides cause male infertility.
Where does one start being decently Skeptical?
Would it not be simpler and much more direct to dose people with pesticides — without greatly increasing the doses they are presumed to be absorbing from their normal fruit and veges — and then send them out into the world to multiply?
And surely any Skeptic can think of several reasons why organic food-eaters might be more fertile than the average member of the population. Do they wear organic ill-fitting underpants?
But there are even more interesting hypotheses to test. We know that we eat about 10,000 times as many natural pesticides as we do synthetic ones (J.D. Mann, New Zealand Skeptic 32). I buy organically grown potatoes because they taste so much better (even though they cost about twice as much), which suggests that they contain a greater and more concentrated range of compounds than the regular watery variety.
Maybe it’s these “special secret ingredients” in the organic fruit and vegetables which serve to boost fertility among Danish males, rather than any tendency for nasty chemicals to diminish the fertility off their less “green” brethren.
And what might these extra compounds be? I presume that the way to raise vegetables which are resistant to the normal range of pests and diseases is to grow them so robust and healthy that their natural defenses are good enough to provide adequate protection. (Any gardener knows that healthy plants are much less prone to disease than sickly ones.) So maybe the reason these Danish organophiles are more fertile is that they are taking in far more natural pesticides than the rest of their countrymen. (And yes they are men!)
Could be it be that our crafty bodies respond to this toxicologic challenge by producing extra sperm to improve the survival chances of our selfish genes?
Who approves funding this stuff — New Zealand On Earth?
New Zealand Skeptic will watch for the outcome with pitchfork drawn and at the ready.
I was driving my car when Kim Hill spent half an hour of public broadcasting time interviewing a woman who claimed to be a Pythagorean Numerologist. The woman claimed that she had not appreciated Pythagoras at school because the teachers focused on arithmetic and all that other dry stuff. But later she learned that Pythagorus was a genuine mystic at heart and was worthy of redemption.
Our numerologist explained to a somewhat sceptical — but not falling-about-the-floor laughing — Kim Hill that Pythagorean Numerology could identify all our personality traits by translating the letters of your born name into numbers and then combining these numbers with the numbers of your birthday.
Evidently we can then all be identified as five/sevens, tens/tens or whatever. As you would expect, a five person could be careful with money, but could be able to overcome this tendency by applying the determination which is also associated with five. These people would make wonderful economists — on the one hand this … but on the other hand that …
Kim Hill did raise the difficulty that Pythagoras used the Greek alphabet, but our numerologist explained that the system had been adjusted to fit the Roman alphabet.
Now if telepathy worked at all, Kim Hill would have heard my 10,000 watt telepathic messages saying “Ask her about the birthdays.” Even Pythagoras could not predict the assumed birthdate of Jesus Christ, so its difficult to imagine him building a numerology system based on his being born on the 30 September 582 BC or whenever. And I cannot conceive of any algorithm which would translate the calenders of Pythagorean times into the Gregorian calendar dates we use now.
Once again telepathy failed me, and we never heard how our numerologist dealt with this problem. However, we learned something about Pythagoras. Evidently he ran a University in which everyone would have been vegetarians, because vegetables, unlike meat, are such spiritual food. I suppose this explains the behaviour of that other famous vegetarian, Adolf Hitler. One of Kim Hill’s questions indicated that our numerologist’s extensive research seemed not to have revealed to her Pythagoras’s famous aversion to beans.
However, my frustration with all this nonsense was eased later on in the morning’s programme when Kim Hill read out a fax from an alert Skeptic who complained bitterly about the use of public radio to disseminate such garbage over the air waves. Well done.
Don’t these programmers realize that this sort of stuff makes it doubly hard to argue in favour of preserving public radio. The more National Radio sounds like No Idea On Air the harder it is for any of us to argue its case for survival.
MSG Myth Laid to Rest
Another sacred cow from my medical school days has been laid to rest. A letter in the New England Journal of Medicine in 1968 triggered a rash of anecdotal reports about facial flushing allegedly caused by monosodium glutamate (MSG) in Chinese food. “Chinese restaurant syndrome” had entered the popular medical mythology. Finally, 26 years later, two Australian scientists conducted a double-blind placebo controlled trial and found that some reaction to MSG was experienced by 15% of the subjects but the same reactions were also experienced by 14% of the placebo subjects. The scientists believe that the true cause of Chinese restaurant syndrome are histamine compounds found in fermented ingredients such as soy sauce, black bean sauce and shrimp paste. New Scientist 15 Jan ’94 p15
A US plastic surgeon found that the majority of his patients presenting for operative penile enlargement were motivated by anxiety over the size of their privy member rather than its performance. In fact one patient’s partner reportedly phoned the surgeon before her husband’s operation and told him she would rather have a fur coat! (GP Weekly) The procedure of penile enlargement was developed in China by the appropriately named Dr Long Daochou.
This absurd operation is not at all unusual in a culture where people also have silicon inserts into their muscles in order to look good at the beach. In fact, Ken and Barbie dolls are good models for such people who prefer plastic moulding to the real thing. Speaking of which, Barbie now has her own spiritual “channeller” (Barbie:”I need respect”!) and a “Barbie Channelling Newsletter”. Sadly, Barbie’s cries for help were treated with derision by Mattel Corporation who threatened the channeller with a multi-million dollar lawsuit. Sunday Star Times 5 June ’94
I was absolutely stunned to read in the Christchurch Press (12/8/94) that the Aoraki Polytechnic in Timaru is planning to offer a three-year Bachelor of Applied Science in naturopathy. Incredibly, the Qualifications Authority (QA) will be visiting the polytechnic to assess the course. The list of “basic sciences” to be studied includes herbal medicine (Kentucky fried medicine) and homeopathy (dilutions of grandeur). Is there anyone out there with any influence on the QA? Should market forces be allowed to dictate what constitutes a “basic science”? These are serious questions.
Can anybody help me come to an understanding of post-traumatic stress disorder (PTSD)? I know it is the new term for what used to be called “shell-shock” but can anyone tell me if the condition is seen in societies which do not have compensation available and are therefore not subject to Welch’s law (see NZ Skeptic 32).
Three passengers on the cruise liner Mikhail Lermontov were awarded a total of nearly $300,000 compensation for PTSD and a further 18 plaintiffs are waiting for their pot of gold. In order for PTSD to have a valid aetiology there must be an equal incidence of cases in the NZ passengers.
I briefly mentioned similar cases related to military service (NZ Skeptic 32) and most people will have heard about “Agent Orange” and alleged links with ill-health in Vietnam vets. It proved cheaper for the manufacturer to settle out of court but this decision has now entered the popular mythology as proof of causation.
Gulf War veterans (something of a misnomer since very few saw any active service) are claiming that symptoms such as fatigue and memory loss constitute a syndrome for which they will no doubt be claiming compensation. (NZ Skeptic 31) I have been following this saga in the medical literature, and investigators are coming up with ever more fanciful theories to explain what is nothing more than mass hysteria. Christchurch Press 14/6/94
A therapist who become famous through treating Diana, the Princess of Wales, has been ejected from his Harley St consulting rooms because his claimed medical qualifications were found to be bogus. Presumably he must have had some success with his treatments but the real Harley St doctors were offended and he had to go. What about the opposite situation — real doctors who persist in offering bogus treatments? We have plenty of these in New Zealand and a medical registration system which can do absolutely nothing about the situation!
There will be no sensible policy on smoking in Israel because the acting health minister, Prime Minister Rabin, is a chain-smoker and refuses to sign a bill prohibiting smoking in public places!
Finally, a common inclusion in 17th century Dutch paintings of women visiting the doctor is a charcoal burner and string. The string was burnt near the nose of hysterical women so the fumes can drive the “wandering uterus from the woman’s upper body back to its proper place in the pelvis.” A quaint theory which has been replaced in our time with food and multiple chemical allergy, RSI, CFS. Have we made any progress? Lancet Vol 343 p 663, BMJ Vol 308 p606, International Express 31/8/94.
Some of you will have noted the derivation of hysteria from the Greek “hysteros” for the female uterus which was thought to wander about the body causing hysteria.
Many of you will remember two cases in the US (where else?) where “poisonous” patients caused ill-health to their medical attendants. The first case concerned a 31-year-old woman receiving chemotherapy for cervical cancer. Following the taking of a blood sample in the emergency room, a nurse noted a smell and promptly passed out followed by other emergency team members. Following exhaustive tests no toxic chemical was found and I quote “no one seems to have seriously attributed the mystery illness to hysteria”. The second case followed a similar course.
Both of these cases are in fact classical examples of mass hysteria which is an unfortunate term with connotations of misbehaviour. Mass hysteria is better described as a contagious psychogenic illness. Psychogenic refers to the production of physical symptoms under conditions of stress and should not be confused with neurosis or malingering. The classical sequence of events begins with a generalised belief about a toxic substance in the workplace followed by a precipitating event, typically, as in the above example, a smell. This perceived threat to health and safety leads to psychological arousal and typical symptoms and signs such as dizziness and fainting. There have been many examples of mass hysteria in New Zealand — the Parnell civil defence emergency 1973 (NZ Med J April 28 1982 p277 and also Australian and NZ Journal of Psychiatry 1975 9:225) and the ICI Chemical fire. Occupational overuse syndrome and sick-building syndrome are good examples of mass hysteria in the workplace.
See Scand, J., Work Environ Health 10 (1984) 501-504) for a good review on the subject.
An advertisement for a course in bioenergetic medicine in GP Weekly (25/5/94) recently caught my attention. The location was the same place where I did a week-long basic acupuncture course in 1987. I spent a week and about $1,000 in total expenses learning a practice which is totally unscientific and can be taught in about half an hour to any intelligent skeptic.
During my course the tutor introduced a market-gardener with alleged “allergy” to tomatoes. The patient was connected up to a Vega machine or equivalent and we were given a demonstration of how his muscle strength was diminished when exposed to the killer tomatoes. A container of steroid was then introduced into the circuit and the muscle “weakness” was cured.
Unfortunately one of the other skeptics in the room had actually removed the vial of steroid from the box and revealed it at the conclusion of the demonstration. Incredibly, the tutor was unfazed and attributed the “improvement” to steroid residues (presumably homeopathic) in the box! Truly a graphic demonstration of the power of belief, one which got me interested in active skepticism as a scientific philosophy highly relevant to my own chosen area of medicine.
I suspect that bioenergetic medicine is very similar to applied kinesiology (AK) where muscle strength is tested while a person is subjected to various influences such as foods, vitamins, homeopathic remedies etc. Controlled studies of AK have repeatedly shown that responses are random under conditions where both tester and test subject are unaware of the substance being tested. My own anecdote is a good example of this. NCAHF Vol 17 No 3 has a brief overview
Fraudulent Food & Drink
Yuri Tkachenko, of the resort town of Sochi, has been given permission by city authorities to “magnetise” the Sochi river and thereby lessen the flow of pollutants into the Black Sea. As the river water quality is obviously a little suspect you might like to try some of his “magnetic” vodka which is guaranteed not to cause hangovers.
On the other hand, if you are mainly worried about getting rid of heavy metals, look no further than a new Hungarian oat-bran extract guaranteed to soak up lead and radioactive strontium carried in the blood stream. The pill, Avenan, has been developed by Lajos Szakasi who needs few lessons in the marketing of quack remedies. Avenan will go on sale as a health supplement rather than a medication because “it can be approved after a simple registration procedure”. To quote Lajos again “I believe the product will be successful because…people will always spend on their health.”
More fantastic still is a report from Japan where Kazu Takeishi has been arrested for giving medical advice and medicines without being properly qualified. It all began with his “healthy” vegetable soup which can be mixed with urine to become a miracle medicine, particularly effective against AIDS and cancer. Kazu claimed to make his diagnoses by touching patients’ knees and the palms of their hands. Like all good quacks Kazu is sure of his market and it’s a good one — $30,000 a day and a two-month waiting list (must have been getting behind on the urine supply). Cancer is a taboo subject in Japanese culture and doctors are even protected in law from informing patients about such a diagnosis.
Now, if I could get the recipe for this soup, I could mix it with urine and treat cancer patients for $300 per consultation and there is nothing the medical council can do — because I’m a doctor!
A Menu of Dietary Delusions
Neither Nutrasweet nor sugar-rich diets produce any change in children’s behaviour. (New England Journal of Medicine 330:301-307, 1994)
The subjects were tested in a double-blind, placebo-controlled trial. The trial was reported in the local press and produced a predictably outraged response from local nutritional quacks who have carried on regardless. Their beliefs are based on faith and are therefore not amenable to reason. For another good New Zealand review see NZ Medical Journal 27/9/89 (Diet and Behaviour) and 23/8/89 (Children’s diets: what do parents add and avoid?).
Evening primrose oil has been touted widely as a “natural” remedy for a host of conditions such as pre-menstrual tension and menopausal symptoms. The active ingredient is gamma-linolenic acid and it was tested in a randomised, double-blind, placebo-controlled trial of 56 menopausal women experiencing episodes of sweating or flushing. It was found to be no better than a placebo.
It is worth noting the value of such studies. Randomisation means that patients have an equal chance of receiving either the “test” substance (gamma-linolenic acid) or a placebo. This ensures that both wings of the trial are identical in terms of age, sex, number of smokers, etc. Double-blind means that neither the subjects nor the investigators know who was taking the “test” substance or placebo until the study has finished. It is no wonder that quacks decry such studies which remove bias, prevent cheating and usually show that quack remedies are useless. (BMJ 308: 501-503, 1994)
These are amino acids and other precursors of neurotransmitters which are being promoted among teenagers at music and cultural festivals. Smart drinks are claimed to “fire up the brain” and give the young executive an “edge”. Could there be anything more loathsome than a hyperactive yuppie? I remember reading about the smart drinks phenomenon in the US and I am not surprised that they have arrived in New Zealand. There is no evidence that smart drinks have any effect on either memory or intelligence. (NZ Doctor 31/3/94)
Sick of Work?
All that is necessary in New Zealand to get a sickness benefit ($22 per week more than the dole for those under 25 years of age) is to persuade a doctor to sign a prescribed form from the DSW.
Over the years I have seen many flagrant abuses of the SB. The best one was a young person who had been on a SB for over two years because of a perforated ear-drum. When I refused to sign the certificate she simply went to a more compliant doctor.
The court news regularly detail the activities of professional criminals and drug addicts who are described as “sickness beneficiaries”. My attempts to find out which doctors were signing these certificates were thwarted by DSW who cited “medical confidentiality”. The great irony is that at the time they were expecting doctors to inform on beneficiaries who were fiddling the system but were not prepared to put their own administration under scrutiny.
A reporter in Germany was able to obtain 41 days sick leave from five different doctors even though he told them he was perfectly well but just wanted a few days away from the office. One visit lasted four minutes, involved no examination and was worth 12 days off! (Dominion 29/3/92, Worker highlights easy access to sick leave)
This sort of abuse arises from poor ethical standards, which also extend in Germany into drug licensing (see Skeptic 27).
Laying On of Hands
The introduction of ACC around 1972 saw a great increase in both the use of physiotherapy and private physiotherapy practices. In Skeptic 29 I commented briefly on the widespread use by physiotherapists of unproven treatment modalities such as ultrasound. Ultrasound treatments have been introduced on a basis of applied experience rather than from controlled scientific study. Dr Linda Maxwell writing in the NZ Science Monthly, March 1994, has studied cellular processes at injury sites and found that ultrasound may enhance inflammation and actually cause more injury.
Physiotherapy is also traditionally used to build up muscle strength in patients with rheumatoid arthritis. A controlled trial by physiologists (New Scientist 16 Oct 1993 p17) found that this approach tended to worsen the flexion deformities seen in this condition. Work continues in the area of electrically stimulating the extensor muscles in an effort to counteract the tendency to flexion deformity.
Most injuries recover with time and I doubt whether the laying on of hands or the use of electrical gadgets by physiotherapists accelerates this process. Many of my patients become upset if they do not receive a referral for physiotherapy and few doctors will refuse in such circumstances.
It is no surprise that costs of the ACC scheme have continued to rise each year. The burden of proving that their treatments are worthwhile rests with the physiotherapy profession. ACC should not pay for any treatments unless they can be shown to be both cost effective and scientifically valid.
The “Alexander Technique” (AT) is an extreme example of the laying on of hands. To quote a recent magazine article, “…by extending the neck and opening the back, it literally makes you taller and releases the body’s natural energy flow”.
Note the typical vague language of quackery: what does “open the back” mean and just what is this “natural energy flow” that quacks keep going on about? The usual anecdotal reports are quoted by satisfied patients: “My singing has improved tremendously…I felt lighter, taller…I’ve learnt to relax by opening and lengthening the back muscles!”
The founder, Frederick Alexander, was born in Tasmania in 1869 and longed to be an actor but suffered a mysterious loss of voice. The rest is worth quoting: “Sitting alone for nine years in a room containing only mirrors and a chair, he studied his position in every detail. It took two years for Alexander to discover only the fact that when he talked he was moving his face and chin forward and contracting the vertebrae in his neck. The muscles of his neck were becoming very tight and causing obstruction in his voicebox.”
I would have described his position as ridiculous and if he found the problem after two years what did he do for the other seven years? How does one “contract the vertebrae in the neck”?
Feeling a need to inform us further about AT the author followed up with three more anecdotal reports from satisfied customers who all described how they feel “happier, more positive, less stressed”.
Quackery has many recurrent themes. The founder of AT suffered a profound illness which was clearly psychological (nine years in a room with mirrors!) and led to him feeling that he had discovered the meaning of life.
The laying on of hands is the basis for the clinical effects (essentially placebo) of most forms of physical therapy such as chiropractic, osteopathy and AT.
Massage and postural “adjustments” are pleasant procedures for patients and it is not surprising that they go away feeling empowered and improved. Unfortunately, many become dependent on therapy and I have met many people who feel it essential to consult such therapists on a regular basis for years. This of course is encouraged by such quacks because it is great for business and they are able to take advantage of people who are incapable of taking responsibility for their own lives and health.
Ischaemic Heart Disease
Ischaemic heart disease (IHD) is a serious public health issue in New Zealand and is the leading cause of death for New Zealand adults. My own father died suddenly of a heart attack while on a golf course. He was 71 years old and had no known risk factors yet autopsy showed severe coronary artery disease.
The costs of treating IHD are considerable and surgical treatment is popular. Political pressure has seen the creation in New Zealand of an absurd number of cardiac surgical units compared to similar western countries. An American study (quoted in Lancet Vol 343 p412) of 1,252 patients showed no difference in employment status after one year between comparable patients who underwent either surgical treatment (angioplasty or bypass) or medical treatment (lifestyle modification, drug treatment).
Angioplasty involves passing a fine balloon catheter into an area of blockage and inflating it, while bypass surgery involves using lengths of vein to bypass the blocked area in the coronary artery. In a subset of 72 patients the median number of days from the start of treatment to return to work was 14 days for medical treatment, 18 days for angioplasty and 54 days for bypass surgery.
Clearly surgery is not always the best option and a lot more of our health resources could be better spent on prevention of this condition by risk factor reduction.
Death or Compensation
A court in the UK awarded a Falklands War veteran $220,000 for post-traumatic stress disorder acquired as a result of serving during that campaign.
This drew a sharp response from the defence editor of the Daily Telegraph (Dominion 10/3/94) who asks how this can be taken seriously at a time when thousands of veterans are converging on Normandy to commemorate the D-Day landings. The Falklands War veteran received his award for the stress of an action over two days! Many WWII vets saw active service for five years and returned to lead happy and successful lives.
Wars are horrible experiences from which soldiers can recover without the need or right to compensation. Post-traumatic stress disorder is simply a New Age euphemism for shell shock, and an insult to all servicemen who have done their duty and returned to civilian life. This absurd monetary award is an example of Welch’s law (after Parkinson): “Whenever compensation is available conditions will emerge to take up the compensation available”.
Deliver Us From Gynaecologists?
In Skeptic 29 I referred to abuses of gynaecology. In Florida, where 25% of deliveries are by caesarean section, the state legislature has forced doctors to change their practices, wanting the rate to be less than 20% by 1997. There is a higher rate of Caesarean delivery among patients with better health insurance and higher incomes, and the rate is lowest in teaching hospitals. (BMJ Vol 308 p432)
Failing the Sex Test
This is the headline of an article which appeared in the Dominion 17/3/94, and concerns an Indian clan which murders unwanted female children. Because of the illegal dowry system, girl children are too expensive so are murdered by being either strangled or smothered soon after birth. The tribe cannot afford amniocentesis which is also abused in order to predetermine sex so that female foetuses can be aborted.
It is important that such cultural practices are highlighted and discussed. It has been interesting to see how various other equally vicious cultural practices have fared following migration to western countries. Some doctors have been de-registered for performing female circumcision and I have even seen a reference in print defending this procedure!
The Indian authorities have taken little action over these murders since the status of women in India remains low. If there are problems over the dowry after marriage, it is a traditional practice to set fire to one’s wife and make the murder look like a kitchen accident.
How far should we go in either acknowledging or accepting traditional cultural practices? Nurses in New Zealand are judged on their “cultural safety” regarding Maori traditions and customs, which fortunately do not honour such abuses as infanticide.
Our intrepid correspondent finds himself suffering from that most fashionable of psychological afflictions, Multiple Personality Disorder!
The Jekyll/Hyde character has been used to express duality in human nature for so long it’s become a cliche. And like most cliches, it’s true.
Everyone has at least one extra personality, and usually more. For example, I seem to be the field of activity for three distinct players — the amiable Dr Jekyll, the despicable Mr Hyde and, much to my consternation, Mrs McPherson, apparently a Scottish Presbyterian.
None of these characters have much in common. Jekyll doesn’t like Hyde and views McPherson as an unimaginative busybody. Hyde hates everyone’s guts and thinks Jekyll and McPherson should be dumped in the knacker’s yard. Mrs McPherson considers Jekyll an impractical dreamer and vociferously wants Hyde consigned to the pits of hell.
Actually, I’m thankful for Mrs McPherson. She’s the only one with the gumption to deal with Hyde. Jekyll is too warm and caring and holistic to wrestle with a degenerate bastard like Hyde. But no one argues with Mrs McPherson.
For the most part this unlikely crew bubbles along in inexplicable harmony, doing good and bringing happiness upon the land. But every so often a defection occurs and one or another goes ape.
It doesn’t much matter if Jekyll gets loose. I mean, what harm can he do? Bore someone to death by telling them to be here now? Scare a neighbour with a bean salad? I like Jekyll, but let’s face it — he’s a wuss.
It’s more nerve-wracking when Mrs McPherson gets out. Mrs McPherson does not tolerate horseplay! Hard work, prudence and the fear of God are her mottoes, and you can either like it or have it taken out of your hide with a hickory stick.
But woe upon us when Hyde escapes! You’ve heard the phrase, “…it’s like the devil gets into him,” well, that’s Hyde. Hyde is the devil. The deceiver, the pillager, the glutton. When Hyde appears, disaster and degradation follow.
You can see why I’m thankful for Mrs McPherson. Jekyll doesn’t have a hope in hell of quelling Hyde’s insane rampages. He’d probably suggest breathing exercises or something. Leave it to Jekyll to try stopping Godzilla with a tennis racket.
These insurrections are usually short-lived, and balance and order are soon restored.
But supposing one of these characters got the upper hand, or broke off and declared himself independent. Holy mackerel! What if Mrs McPherson seized control!
Imagine being possessed by a Bible-belting, turn-of-the-century, galleon-shaped, prohibitionist women’s rights activist! The very thought makes me nervous.
Heck, if Hyde staged a coup, most likely I’d just end up dead or in jail. But if McPherson managed a takeover I’d have to do really weird things like dynamite disco joints and drive money-lenders out of the temple and stuff like that. It’s too much to even think about! Thanks to Jekyll’s goofball influence I just don’t think I’m emotionally prepared for demolishing bar-rooms with axes and driving harlots into honest work.
But worse still, spirit mediums and New Age journalists would proclaim me a legitimate case of possession and write books about it and make me talk about sin and redemption and magnetic healing on talkback radio.
It’s like Flash Gordon Versus the Psychic Vampires, except worse. Flash’s foes were little more than mind-draining bat people. Anyone could deal with that. But what in the name of all that is merciful do you do about Mrs McPherson?
The terrible thing is, I know she’s in there. Waiting. Waiting to escape. Waiting to ban tobacco and catch kids chewing gum in class.
First she’ll take my mind, then yours, then the country, the planet, the solar system, the…
Make no mistake; Mrs McPherson must be stopped.
Arthritis and Placebos
In Skeptic 30, John Britten outlined the tragic results which can occur when patients fall into the clutches of quacks. In this case, a man with rheumatoid arthritis was not only starved but ended up paying for expensive and useless medications. Most doctors can relate similar examples.
Uncontrolled trials claimed to show dramatic improvements in rheumatoid arthritis patients following laser treatment. However, a placebo-controlled trial showed that sham treatment (placebo) gave just as good results as the laser. (BMJ Vol 307 30 Oct 1993 p1154)
A placebo-controlled trial of diclofenac (an anti-inflammatory drug) for osteoarthritis of the knee, found that half of the patients allocated to placebo stayed on this treatment for two years without any worsening of their symptoms! (BMJ Vol 307 Aug 1993 p394)
Reports of pain relief from subcutaneous injections of water drew a sharp reply from Skrabanek writing in the Lancet (April 3 p905). He pointed out that a historical perspective of such “counter-irritation” methods can help prevent over-enthusiastic adoption of such unlikely treatments. In fact, I seem to remember that water injections were one of the scams exposed in the novel by A.J. Cronin, The Citadel, which should be required reading for any doctor of medicine.
Gulf Gas Mystery
An article in Time magazine (Nov 22 1993) outlines how 8,000 veterans of the Gulf War have claimed that they were exposed to chemical agents producing such symptoms as diarrhoea, aching joints and difficulty in breathing. It is alleged that “multiple chemical sensitivity” may be the cause but nowhere is there any mention of psychological causes such as stress. Many of the claimants have been dismissed as malingerers.
War is hell and it is a terrible experience for some soldiers. Stress-related disorders are common and resulted in shell shock and effort syndrome in WW1, anxiety neurosis after WW2 and alleged Agent Orange poisoning after the Vietnam war. History shows that such claims will continue to occur, as in this case, but I would prefer to see psychological causes included in the differential diagnosis.
Sick Building Syndrome (SBS)
Researchers have finally got around to acknowledging that SBS may be due to “a high level of job stress among individuals with symptoms” (GP Weekly 19 Jan 1994 p15). As would be expected there are now concerns about “sick plane syndrome” (SPS) reported in New Scientist (7 Aug 93 p7). Several cabin attendants reported difficulty breathing, dizziness, fatigue, nausea and headaches during a cross-country flight. “The cause was never determined.”
I wonder if they considered mass hysteria, which is the most likely scenario for both SBS and SPS. Hysteria is not the best word to use — perhaps mass conversion disorder is less pejorative. Essentially, groups of people under stress tend to develop similar symptoms in the face of a common stress. A good example which I have seen myself is mass fainting occuring in military recruits awaiting both blood tests and vaccinations.
Christian “Scientists” believe that illnesses can be healed with prayer and Bible readings. The religion’s founder, Mary Baker Eddy, was described by Mark Twain as the “queen of hypocrites”. There are numerous examples of people who have died from lethal but eminently treatable conditions. I have no problem with deluded adults who want to be treated in this way but children are entitled to a standard of medical care expected by any reasonable parent.
As would be expected from common sense, there is no evidence that faith has ever produced a cure of any illness. Is it at all likely that faith can produce insulin secretion from a failed diabetic pancreas? In the US, a couple killed their diabetic son by withholding treatment for his diabetes (Lancet Vol 342 Sep 4 1993 p610). Incredibly, the parents were not criminally prosecuted because of “a state law that protects from child neglect statutes, parents who rely on prayer to heal their children”. However, the child’s estranged parent filed a civil suit and the Christian Science church has been ordered to pay US$11.3 million in damages.
The law in the UK seems more rational. A Rastafarian couple refused on religious grounds to allow their diabetic daughter to have insulin and she duly died. As any reasonable person would expect, the parents were charged with manslaughter and convicted (Lancet Vol 342 Nov 13 1993 p1189).
More on Dental Amalgam
As I have previously explained, there is no evidence to implicate mercury in amalgam with significant human illness. An article in the Marlborough Express (24/8/93) outlined an illness which caused weight loss, stomach cramps and nausea in a 34-year-old man. After paying more than $2,000 in medical bills he was no better. As a doctor I know straight away that there is only a slight chance of a significant organic illness (e.g., cancer) either occuring or being overlooked in a 34-year-old.
I have seen this combination of symptoms before in many patients and they all turned out to have depression and were cured with appropriate treatment. However, as I have mentioned many times, psychological causes for illness are seen as somehow inferior to a “physical” cause. To quote the patient: “I was getting worried that it was something psychological. The medical profession was giving me ideas that it was depression, stress, bodily changes.”
In this case, the patient received a diagnosis of “mercury poisoning” following an assessment with a quack “black box” involving electroacupuncture. He then paid $1,000 to have all his amalgam fillings replaced and is reported to be slowly improving. Truly another remarkable example of the placebo effect which is very powerful with any kind of surgical or operative treatment.
These are symptoms or signs produced by notional beliefs (e.g., mass fainting due to a perceived chemical or environmental threat), and are the basis of occupational overuse syndrome, chronic fatigue syndrome, sick building syndrome etc.
“Retractor” is an expatriate Kiwi living in Australia who wrote an interesting article on allergy to local anaesthetic (LA) (NZ Doctor 16 Sep 1993 p7). He found that patients demonstrated their “allergic” reactions even when injected with normal saline solution.
One 12-year-old had fits after dentally administered LA and was investigated with two electroencephalograms (brain-wave recordings), a CT scan and a MRI scan. Following an injection of normal saline (which the patient believed was LA) he had a fit and was incontinent!
“Retractor” was mostly successful in helping patients deal with their subsequent embarrassment but some had trouble and went so far as to dispute the matter. Descartes was certainly completely wrong when he proposed his theory of complete separation between mind and body. Clearly the mind (belief) can have a potent effect on the body.
Pond Scum Scam?
Pro-algal quacks claim that algae harvested from a pond “may be beneficial” for the treatment of AIDS, cancer, heart disease, etc. The product has re-surfaced since the FDA shut down the marketing company, Cell Tech, in 1986.
Note the absurd range of indications of the product, in contrast to the specific use of drugs for particular diseases.
The FDA faces an uphill battle in countering this sort of quackery, as the law is vague on whether such items should be classified as drugs, foods or dietary supplements. A sensible law was passed by Congress in 1990 which prohibited any health claims about such products unless approved by the FDA. The powerful quack lobby has managed to introduce another law which dilutes scientific standards and shifts the burden of proving safety onto the FDA!
C is for Cancer
Linus Pauling’s faith in Vitamin C is undaunted by his cancer (NCAHF Vol 15, No4). Despite it being out of his field (nuclear physics), Pauling has championed the anti-cancer benefits of Vitamin C. Sadly, he has been diagnosed as having prostate cancer but, despite being poorly, his faith in Vitamin C is unshaken. “He credits his high-C regimen with delaying the disease until his present age of 91 yrs.” The physiology of Vitamin C is well described, and excessive amounts are simply excreted in the urine. Prostatic cancer occurs more often with increasing age and if men live long enough there is an almost 100% incidence.
Pauling has helped keep Vitamin C as the number two on the list of the top dietary supplements in the US. Dietary supplements are worth $1.4 billion US annually and are currently 37% of all health food sales.
Oil Strikes Out
The film Lorenzo’s Oil concerns the efforts of a family to save their son from a rare genetic disorder using a highly purified cooking oil of the same name. Thanks to the media there is now a new popular mythology that the oil is effective and that attempts to use it have been obstructed by the unreasonable medical profession.
A French team of scientists have tested the oil and found no evidence of any clinical benefit. Once again, extravagant claims are found wanting when subjected to critical scrutiny.
If You Can’t Beat ’em?
Bernard Howard first drew my attention to worrying trends towards the inclusion of unorthodox therapies into conventional medical practice.
The BMA has acknowledged that acupuncture, osteopathy, homeopathy etc. are “indeed a good thing” provided the practitioners are “properly qualified members of their crafts”. In an article in New Scientist (31 July 1993), Donald Gould comments on this Pauline conversion and accuses the medical profession of a change prompted by concern over the loss of patients to alternative medicine. A “properly qualified homeopath” is still a quack peddling water, and professional registers simply give quackery a spurious respectability.
The NCAHF has already shown how licencing of quackery is soon followed by that body actively lobbying for an expanded scope of practice. In New Mexico, the state Acupuncture Board allows acupuncturists to order tests and procedures such as MRI scans, writing prescriptions and performing bone and muscle manipulations. Chiropractors were predictably indignant and two doctors on the Board resigned in protest. (NCAHF Vol 16, No 5).
I briefly commented on this trend in Skeptic 30 (“Quackery in the US”). The Office of Alternative Medicine has been set up within the US National Institutes of Health at the instigation of a former congressman, Bedell, who claims to have been cured of a “possible recurrence” of prostate cancer by an unconventional “nitrogen enhancement” therapy (unspecified). What Bedell does not say is that he was also receiving conventional treatment for prostatic carcinoma and “possible recurrence” is an example of the meaningless terms and vague language that permeates alternative medicine.
The director of the Office holds establishment credentials and describes himself as a skeptic, yet favours simple outcome studies rather than the proven double-blind, placebo-controlled trial. Outcome studies are weak and will allow for all sorts of extravagant claims. The reason that quacks hate proper clinical trials is that they usually show that quack beliefs are a delusion.
Members of the Office of Alternative Medicine can use their affiliation to advertise their quackery because, as an ad hoc body, they are not subject to normal regulations. One of the members has already claimed to have cured AIDS using herbs. No evidence was offered to support such an extravagant claim.
In New Zealand the ACC will pay for acupuncture, which is an unproven treatment, on the referral of a doctor. I had a patient with a severe neck injury which required (on the advice of a specialist neurosurgeon) an MRI scan but ACC does not pay for this test because it is “not an approved investigation”! This is a good example of politics controlling medicine, instead of science.