Snake oil, water and acid – a very sad mix

A fiasco over a ‘Natural Therapy Clinic’ at Wanganui Hospital was finally resolved satisfactorily – but for the wrong reasons.

The attempted introduction of ‘natural therapy’ to Wanganui Hospital has been yet another appalling demonstration of the failed leadership, governance and management structure of the Whanganui District Health Board.

Whilst clearly recognising all our rights to pursue personal and spiritual health, wellbeing, happiness and pleasure, my view is this: New Zealand hospitals, established with public funds and administered by the Ministry of Health, must follow the principles of evidence-based care.

I have a high level of interest and involvement in things spiritual and religious. I am an ardent advocate of patient and broader human rights and strongly support and respect our indigenous people and the Treaty of Waitangi.

However, and a big however, as a trained scientist, specialist General Surgeon and third term elected member of the Whanganui DHB, I have been appalled at what has unfolded in the attempted introduction of ‘natural therapies’ to our public hospital here.

I think I understand the sentiments that might have driven this initiative. Indeed I also have a degree of sympathy with its proponents, who almost certainly meant well.

The arrogance of thinking within Western medicine that excludes possible benefits of other modalities of healing is not warranted. An environment lacking in empathy and caring is all too common in our public hospitals and also needs to be dealt with. So too, the awful health statistics of our under-privileged population – in which Maori are sadly over-represented.

However, even a cursory examination of what has transpired in this failed process reveals serious and very worrying realities of the state of stewardship of the provision of medical care in New Zealand.

The initiative to establish a ‘Natural Therapy Clinic’ at Wanganui Hospital saw the formal establishment of the service via an early morning blessing at Te Piringa Whanau on Monday 23 July at 7.45am. The service was led by local kaumatua John Maihi and Wanganui Hospital chaplain Rev Graham Juden.

Despite obvious months of planning and detailed preparation, this was announced via a press release of 19 July1, just three days before the formal launch.

This was the first word of this initiative breathed to members of the Whanganui District Health Board. Not a single mention of it was made by the CEO Julie Patterson to her board – not even a hint in her weekly email updates to board members, the last one appearing just days before the launch. For a board that runs on the premise of ‘no surprises’ from its CEO, this is disturbing.

This is especially concerning since the media release in January 2012 suggesting (with the blessing of local obstetric specialists) that Wanganui might soon have no obstetric service was also never formally discussed at a board meeting. This created six months of chaos and anxiety for our community.

Termination

Fortunately, like the absurd idea of not providing an acute obstetric service to a city of 45,000 people, the ‘Natural Therapy Clinic’ idea has been terminated.

Interestingly, the scheme was cancelled just days before it was to be presented to the board. The only way I was able to get it to the board table at all was to link the idea of allowing non-accredited ‘practitioners’ loose on our patients with the recent case of alleged sexual abuse of one of our patients by a mental health care assistant in our organisation.

The CEO reported at the time2:

” Almost 12 months ago we received a complaint from a young woman, one of our mental health clients. The complaint alleged that she had been raped by a Health Care Assistant (HCA). The staff member was immediately suspended and the complaint investigated. It was found that the staff member had had inappropriate contact with the woman (texting and meeting her away from the unit) and a strong suspicion that there had been a consensual sexual relationship. The staff member resigned but was informed in writing that the outcome of the investigation was that he would have been dismissed. As this person was part of the unregulated workforce, we had no other levers.”

How much more blatant a lesson does one need to realise the obvious pitfalls of not only allowing, but encouraging, unregulated workers access to our patients?

The ‘paper’ which was finally presented to the board was the usual inept documentation supplied for board members and was lacking in even the rudiments of scientific form or rigour.

The claim that the pilot programme received “overwhelmingly positive feedback from staff”3, is perhaps one of the more obvious areas of deception in all this.

A survey of the 75 staff members who chose to use the service at its pilot stage apparently showed a positive response. However, of course, this is a self-selected group of less than seven percent of hospital staff members who wanted to avail themselves of the service in the first place. The views of the other 93 percent of staff are not canvassed or recorded.

But this is characteristic of DHB doublespeak.

The first media release of 19 July concerned me on a number of levels. The fact that the board had not been consulted was one. Board sets policy; management is tasked with implementing it.

All too often in our fragile district, management has implemented unjustifiable actions and then looked to the board for support after the fact. That support has understandably and correctly for the most part not been forthcoming.

An open-ended field

The second concern was the lack of definition of ‘Natural Therapy’ and the open-ended inclusion of all comers, including traditional Maori healing, Christian prayer, massage, Reiki and meditation training, as treatment modalities.

More recently, and again without prior notification, we learn through the media3 that ‘colour therapy’ was also included in this array.

None of these can seriously or accurately be considered to be therapies any more than a warm bubble bath or hairdressing could be. That does not mean that they necessarily infer harm – of course the latter two do not. Furthermore, it does not mean that hairdressers and bubble bath are not allowed or even encouraged in our hospitals: of course they are. They simply are not therapies. They are nice things and we can choose to use them in or out of hospital if we wish at our own whim.

The provision of Traditional Maori Health is already recognised by our Ministry of Health and appropriately funded and provided outside of hospitals. One could well argue that this is a legitimate part of the history and culture of New Zealand and like the Maori language is worthy of respect and support. I agree. This is a noble sentiment, and one supported by our government, but any serious practitioner of traditional Maori healing would no sooner practise his art in a backroom of Wanganui Hospital then I would perform a laparotomy in the staff canteen.

Confusion

It is curious that the reported formal line of the organisation as to why the project was shelved was to “avoid confusion and anxiety in the community which we are here to serve”. That confusion, however, has been created by the management team of what is supposed to be a first-world public hospital formally suggesting through one of its most prominent specialists that the likes of ‘colour therapy’, prayer and body rubs might have any serious therapeutic benefit.

Indeed, in a study of some 1200 patients published in the American Heart Journal4 prayer clearly has been tested and shown to have no such effect.

My greatest concern, until recently, was that this project was initiated and sustained by a medical specialist colleague Dr Chris Cresswell, who is a Fellow of the Australasian College of Emergency Medicine (FACEM) and boasts vocational registration with the New Zealand Medical Council.

Code of Ethics

Our own Medical Association of New Zealand code of ethics requires us to “[a]dhere to the scientific basis for medical practice while acknowledging the limits of current knowledge.”5

It is entirely inappropriate for us to use our acquired medical positions and titles to actively promote in a formal way practices that clearly are not evidence based.

The issue is not that these modalities have no value. For individuals they clearly do. It is not that they might do harm; they probably will not. The issue is a gross breach of our commitment to our patients to apply best practice and evidence-based models to their care.

Furthermore, the notion that individuals who are essentially unaccountable and unrecognised by professional bodies and standards should be unleashed on our patients is at best irresponsible. That one of our senior doctors &#8212 Dr Cressell &#8212 in his professional capacity was using his medical qualifications and status to promote these people and suspect modalities should be a matter for the Medical Council to act on. These are not acceptable treatment options. They might well be nice and comforting and like hand-holding and hairdressing, patients are at liberty to use them at their own behest even in our hospitals. They are not to be formally prescribed by doctors using their medical credentials to promote snake oil. These are not therapies; these are not credentialed practitioners. These are at best warm fuzzies and do not require ‘clinics’ endorsed by our doctors. They have no place in our hospitals any more than homeopathy, devil worship or nail painting does.

I was surprised that the hospital CEO, Clinical Board and Association of Senior Medical Staff supported this poorly conceived idea at the outset. They did. They most certainly did.

Not one of my medical colleagues locally spoke out against this plan. Not one spoke out in support of high-quality, first-world, evidence-based medical care of which we should be unambiguously proud.

Common sense?

Then suddenly, the idea was dropped. I thought some common sense had prevailed.

The real and greatest concern, though, is this. Our CEO and board chair refused in the public section of our board meeting to properly explain why the project was so suddenly stopped in its tracks.

The answer lies not in medical ethics, science, patient concern or professionalism. Astoundingly, it seems, it lies not in a rational, scientific concern for evidence-based practice and a concern for who precisely we allow to have access to our patients. It lies, rather, in religiously based paranoia and bigotry.

A Wizard at the hospital

On 6 September 2012 an advertisement article appeared in the Wanganui River City Press titled ‘Dreams, magic, healing and medicine’6.

This promoted a talk to be given by Dr Cresswell on a number of topics including the ‘Natural Therapy Clinic’ and his proud introduction of it to Wanganui Hospital.

Sadly for Dr Cresswell and the ‘Natural Therapy Clinic’ the article disclosed the fact that Dr Cresswell is an ordained Wizard in the Whanganui School of Witchcraft and Wizardry, a clearly unchristian organisation and the meeting was part of Theosophy Wanganui.

I guess that degree of open mindedness, free spirit and lateral thinking on the part of Dr Creswell is what led him on his natural therapy crusade. I must confess to a degree of admiration, kinship and support for his wide raging interests, but alas, like business and pleasure, some things are best not mixed.

We can deduce it was the wizardry of Dr Cresswell that drove the medical professionals to object to the scheme. Not science, not ethics, not professionalism. Rather, we are told, “it was contrary to their religious beliefs”.

I’ve been told more than once my problem is that I think too much.

That’s probably true, but what has happened is not only mind boggling and sad, but frighteningly revealing on a whole number of levels.

A well-meaning ‘good guy’ doctor probably crossed the bounds of professionalism by formally elevating feel-good modalities to therapies. An ill-informed management team jumped on the bandwagon and Maori health was usurped in an attempt to ooze credibility over other unrelated claptrap practices.

The Health Board members were never consulted and some well-deserved bad press followed. Sadly, the Medical Council of New Zealand and the Ministry of Health provided no guidance and remained silent whilst all this unfolded. Happily, some very influential Wanganui senior doctors killed the project after previously supporting it. Sadly, it seems it was because of their own religious and personal bigotry that a silly idea was ended.

Great result, bad motivation. Very bad motivation.

Medical ethics

Vicki Hyde of the NZ Skeptics7 points out:

“It’s rare for public figures to come out against these ‘soft’ services. It´s easier to ignore the ethical and evidential issues associated with claims that these kinds of practices actually help to treat illness or disability beyond exploiting the well-recognised placebo effect.”

It is imperative that as doctors, our first responsibility must be to our patients. Of course, we need to be cognisant of our limitations, humble, not arrogant and open to all the needs of our patients. But we are trusted as a profession and that trust can only be maintained if we adhere to defined standards based on evidence and ongoing re-evaluation and scrutiny. We should not promote, via our medical qualifications, unproven modalities at the level of treatment modalities. But neither can we allow our own specific religious affiliations to affect our professional conduct with respect to our colleagues who might hold different or indeed no religious affinities.

As trained medical practitioners we must boldly uphold the scientific basis of our profession and never be compromised by political correctness or political claptrap and doublespeak.

Saving grace?

The supposed saving grace in all of this is that ( we are told) no taxpayer money was spent on this project. My Official Information Act application will shed some light on that. But note, apart from the media releases, the following occurred8:

  • A credentialing committee was established, including Dr Cherryl Smith (Co-Director of Te Atawhai o Te Ao), Dr Chris Cresswell, Gilbert Taurua and Runesu Masaisai (WDHB Clinical Therapies Manager).
  • Dr Chris Cresswell was to extend his professional development on natural therapy as part of his credentialing requirements as recommended by the clinical board.
  • An independent legal opinion was sought which resulted in the WDHB’s insurance company providing approved cover for the pilot.
  • Therapists were required to become honorary DHB staff ensuring compliance with all WDHB expectations, policies and procedures.
  • Systems were established to obtain confidentiality agreements from all therapists.
  • Therapists were required to be police checked.
  • Therapists were referee checked and cleared by both steering committee and credentialing committee.
  • A memorandum of understanding was developed specific to the therapists collective.
  • Informed patient consent expectations and documentation were established.
  • The orientation programme for therapists included: WDHB purpose, values and behaviours, fire and emergency evacuation, infection prevention and control, manual handling, patient safety and service quality including complaints, privacy and the code of rights, CPR and smoking cessation.

That appears to be a lot of taxpayer funded work to me.

Some appointed members of the Whanganui DHB tried to excuse this whole debacle by suggesting that this was all just a staff benefit scheme and never intended for patients. They clearly never read their press releases and have been patently out of touch with this important process, or worse, have compromised their own integrity in order to cover for a failing and flailing management.

To add insult to all these injuries, in an attempted justification of the failed project, Julie Patterson made the public comment that “in areas like ‘chronic pain’, Western Medicine has nothing to offer.” Really?

With views like that from high earning health bureaucrats, doctors, nurses, the Medical Council and the Ministry of Health have sure got a lot of work to do.

In the face of all of this nonsense, we cannot and should not remain silent.

References
1. Whanganui District Health Board Press Release 19th August 2012.
2. Weekly update, CEO Whanganui District Health Board 21st May 2010.
3. Wanganui Chronicle 26th September 2012. Hospital Ditches Natural Therapy, Anne-Marie Emerson.
4. Benson H et al. 2006: Am Heart J. 2006 151(4):934-42.
5. Medical Association of New Zealand Code of Ethics. www.nzma.org.nz/sites/all/files/CodeOfEthics.pdf
6. River City Press Sept 6th 2012 Dreams, magic, healing and medicine.
7. NZ Skeptics press release 24th August 2012,www.scoop.co.nz/stories/AK1208/S00554/consumer-wins-bent-spoon-again.htm
8. Wanganui District Health Board Meeting 28th September 2012 Item 10.2.
Clive Solomon is a Consultant General Surgeon, elected member of the Whanganui DHB (third term) and a Wanganui District Councillor. [Editor’s note: Organisations referred to in this article differ in their preferred spelling of Wanganui or Whanganui.]

The (bad) science behind the MMR hoax

The world-wide panic over the MMR vaccine was sparked by the actions of one doctor who breached several standards of scientific practice. This article is based on a presentation to the 2010 NZ Skeptics conference.

Every few years, the World Health Organisation (WHO) publishes a series of ‘death tables’, a summary of how many people died in a given year and the causes of death. The tables make interesting reading. The figures published for 2004 show that a third of all deaths worldwide were due to infectious diseases, a staggering 15.1 million people1. Of these, four million may have been prevented by vaccination.

As a microbiologist, I am staggered by the growing anti-vaccination movement. Vaccination has to be the success story of ‘modern’ medicine. Just look at the benefits: vaccination can provide lifelong protection, does not rely on correct diagnosis or treatment being available and can avoid some forms of auto-immune disease that can be triggered by infection. As the saying goes, prevention is better than a cure. While it is true that vaccines are not 100 percent risk-free, the benefits to both the vaccinated individual and the wider community (through ‘herd immunity’) far outweigh the risks.

What is fascinating about vaccination ‘hysteria’ is that different countries have different scares, even though they are using the same vaccines. One such scare, which has resulted in a resurgence of measles in a number of countries, relates to the MMR vaccine. This is a freeze-dried preparation of three living but disabled viruses: measles, mumps and rubella. In the 1990s, a British doctor by the name of Andrew Wakefield claimed there was a link between MMR vaccination and autism. He claimed to have discovered a new syndrome, which he called autistic colitis, in which autistic children were found to have a particular kind of gut disease.

He also claimed to have found that the appearance of symptoms of autism coincided with MMR vaccination, and children with autistic colitis had measles virus in their guts. His findings were based on a study of 12 children with developmental and intestinal problems, published in the Lancet medical journal in 19982. Nine of the children were diagnosed with autism. The children were believed to have been developing normally and then suddenly regressed, and parents were asked to recall how close to the time of MMR vaccination the symptoms appeared.

The study suffers from a number of crucial flaws, not least the lack of blinding or control groups, or potential for parents to incorrectly recall the appearance of symptoms. It also turned out that Andrew Wakefield had numerous conflicts of interest: he was receiving money from lawyers looking to build a case against a vaccine manufacturer, had submitted a patent on an alternative measles vaccine, breached ethics compliances and even paid children at a birthday party for donating blood.

The journalist Brian Deer was instrumental in bringing all of these conflicts to the public’s attention and has maintained a website (briandeer.com/mmr-lancet.htm) summarising his investigations into Wakefield and the MMR debacle. Recently, the British Medical Journal (BMJ) commissioned Deer to write a series of articles summarising his findings3-5. In 2010, Andrew Wakefield was found guilty of misconduct and struck off the medical register in the UK and the Lancet finally retracted his paper.

In an editorial accompanying one of Deer’s articles, the BMJ’s editors asked:

“What of Wakefield’s other publications? In light of this new information their veracity must be questioned. Past experience tells us that research misconduct is rarely isolated behaviour.”

What of his other work? Indeed, the Lancet paper was just the first in a series of papers by Wakefield attempting to link autism with measles. One of the things he showed was that measles virus could be detected in the guts of autistic children using a technique called the polymerase chain reaction (PCR). PCR is a fantastic technique used to amplify very small amounts of target genetic material to generate over a billion copies. In a nutshell this means PCR can take something that is undetectable and make it detectable. However, one of the downsides of such a sensitive technique is that it is very easy to contaminate, so proper controls are really important. For those who want to know how PCR works, there are some very nice videos online (youtube/eEcy9k_KsDI).
One of the crucial things needed to carry out PCR is a set of very specific ‘primers’ which recognise the region of genetic material that you want to amplify (Fig 1). You need primers to each end of the region of interest and then PCR amplifies the bit between the primers. So if the primers match the wrong region, you will end up with a large amount of the wrong thing, a classic case of garbage in, garbage out. So the important things to remember are:

  1. The primers need to be specific so that they only amplify what you are targeting and nothing else.
  2. You have to be very, very careful not to contaminate the reaction.

To make sure the primers are specific and nothing has been contaminated, it is crucial to include a number of controls alongside the samples being tested:

  1. A negative control which has water in place of any target genetic material which will tell you whether you have had a contamination problem or not.
  2. A negative control which has control genetic material that does not contain any of the target sequence which will tell you if your primers are specific enough.
  3. A positive control which has genetic material that does contain the target sequence which will tell you if your reaction has worked.

So, you have your samples and your controls, the PCR machine has done its dash and you are left with a little tube filled with billions of copies of the target sequence (or none if the sample was negative…). This can then be visualised by gel electrophoresis and you are left with something like the picture in Fig 2.
Lane 1 contains a size standard, lane 2 is the negative control containing no genetic material, lane 3 is the negative control containing no target sequence (the very faint band is just the background genetic material), lane 4 is the positive control containing the target sequence and lanes 5 and 6 are our unknown samples (which in this case are all positive). It is important to say here that very rarely would you see an actual gel published in a paper. Most results are just described as the number of positive or negative samples. This is important as it leaves the reader assuming the correct controls were done. But it doesn’t end with gel electrophoresis. To make absolutely certain, the amplified genetic material can be sequenced to confirm it is the correct thing. And if the claims you are making are wide-reaching and/or controversial then sequencing is exactly what should be done.

Andrew Wakefield hypothesised that exposure to the measles virus in the MMR vaccine was a factor in the emergence of his so-called ‘autistic colitis’ and that genetic material from the measles virus would be found in patients with the disease but not healthy controls. He supervised PhD student Nick Chadwick to investigate. The first paper they published (in January 1998) was in the Journal of Virological Methods, reporting a “rapid, sensitive and robust procedure” for amplifying measles RNA6. In August 1998 they published a second paper describing the use of the procedure to look for measles virus in samples from patients with inflammatory bowel disease (IBD)7. They state:

“These results show that either measles virus RNA was not present in the samples, or was present below the sensitivity limits known to have been achieved”.

They then went on to look at the children reported in the, now retracted, Lancet paper (that is, the ones with ‘autistic colitis’). Wakefield never published these results but Nick Chadwick did write up his PhD thesis in 1998. Brian Deer has put the relevant information from the thesis on his website (briandeer.com/wakefield/nick-chadwick.htm). Nick Chadwick concludes: “None of the samples tested positive for measles, mumps or rubella RNA, although viral RNA was successfully amplified in positive control samples”. Despite this negative result from 1998, Wakefield then appears as senior author alongside a team of Japanese researchers in a paper published in April 2000 in the journal Digestive Diseases and Sciences8 where they report the detection of measles virus:

“One of eight patients with Crohn disease, one of three patients with ulcerative colitis, and three of nine children with autism, were positive. Controls were all negative. The sequences obtained from the patients with Crohn’s disease shared the characteristics with wild-strain virus. The sequences obtained from the patients with ulcerative colitis and children with autism were consistent with being vaccine strains.”

In 2002 Wakefield then published another, bigger study of children suffering ‘autistic colitis’ with a team from Ireland9. They reported:

“Seventy five of 91 patients with a histologically confirmed diagnosis of ileal lymphonodular hyperplasia and enterocolitis were positive for measles virus in their intestinal tissue compared with five of 70 control patients.”

Yasmin D’Souza and colleagues at McGill University in Canada published a very nice study in 2007 in which they compared the primers used by both the Japanese and Irish groups with their own primers for the measles virus on a range of IBD and control intestinal biopsy samples10. Any positive samples were verified by sequencing.

And the results? The primers used by Wakefield and colleagues weren’t specific for measles virus. In fact, the amplified fragments were found to be of mammalian origin. What this means is that human samples should all be positive. Unsurprisingly, when D’Souza tried using genuine measles specific primers they “failed to demonstrate the presence of MV [measles virus] nucleic acids in intestinal biopsy samples from either patients with IBD or controls”. They also failed to find any measles virus in samples taken from over 50 autistic children11. This does suggest that Andrew Wakefield’s research conduct does not stop with the Lancet study.

There is now a huge body of evidence indicating that there is no link between vaccination and autism. Despite this, Andrew Wakefield is held up by many as a hero, fighting a corrupt system with the ‘evil’ pharmaceutical industry at its centre. Wakefield has recently published a book entitled Callous Disregard: Autism and Vaccines – The Truth Behind a Tragedy. One reviewer wrote:

“Dr. Wakefield sets the record straight. It was not he who showed callous disregard towards vulnerable, sick children with autism. It was the British medical establishment, the General Medical Council, the media and the pharmaceutical industry that threw the children under the bus to protect the vaccine program. This is a book for everyone who cares about our future”.

Who needs evidence, hey?

References

  1. WHO website. www.who.int/healthinfo/global_burden_disease/en/
  2. Wakefield AJ, Murch SH, Anthony A, et al. (1998). Lancet 351(9103): 637-41. RETRACTED.
  3. Deer B (2011). BMJ. 342:c5347. doi: 10.1136/bmj.c5347.
  4. Deer B (2011). BMJ. 342:c5258. doi: 10.1136/bmj.c5258.
  5. Deer B (2011). Secrets of the MMR scare. The Lancet’s two days to bury bad news. BMJ. 342:c7001. doi: 10.1136/bmj.c7001.
  6. Chadwick N, Bruce I, Davies M, van Gemen B, Schukkink R, Khan K, Pounder R, Wakefield AJ (1998). Virol Methods. 70(1):59-70.
  7. Chadwick N, Bruce IJ, Schepelmann S, Pounder RE, Wakefield AJ (1998). J Med Virol. 55(4):305-11.
  8. 8. Kawashima H, Mori T, Kashiwagi Y, Takekuma K, Hoshika A, Wakefield A (2000). Dig Dis Sci. 45(4):723-9.
  9. 9. Uhlmann V, Martin CM, Sheils O, Pilkington L, Silva I, Killalea A, Murch SB, Walker-Smith J, Thomson M, Wakefield AJ, O’Leary JJ (2002). Mol Pathol. 55(2):84-90.
  10. D’Souza Y, Dionne S, Seidman EG, Bitton A, Ward BJ (2007). Gut 56(6): 886-888.
  11. D’Souza Y, Eric Fombonne E, Ward BJ (2006). Pediatrics 118(4): 1664-1675.

Hokum Locum

Skull manipulation takes a lot of ‘training’

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

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

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

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

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

Iridology

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

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

Chinese Frauds and Dangerous Products

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

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

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

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

Dominion Post 24 March
BMJ 9 June 2007 Volume 334 p1183

The Culture of Complaint

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

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

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

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

Marlborough Express 26 April

Physiotherapy

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

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

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

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

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

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

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