History repeats

A visit to the birthplace of science prompts some thoughts on spatial and temporal patterns in alternative medicine.

There is no special reason for skeptics in New Zealand to follow news from Greece. Last year, however, Waikato University signed an agreement for staff exchanges with Aristotle University in Thessaloniki, and I put my hand up to go. The GNP per head in Greece is about the same as in New Zealand, and teaching at Aristotle University is in English, so exchanges between the two institutions are feasible. As someone who is as good at learning foreign languages as chiropractors are at curing diseases, I was delighted that learning Greek was not necessary. Plus, when I visited there in 2004, a barman refused to let me pay for my drinks because Kiwis and Greeks fought alongside each other in the 1941 Battle of Greece. Now, a mention of anything Greekish makes me take notice. What I have learned is that Greece-arguably the birthplace of science – has repeatedly faced issues similar to those that occupy us in New Zealand.

For example, after World War II, Greece was struggling to rebuild after great suffering. For example, thousands of Jewish men, women and children in Thessaloniki had been packed on to trains and killed in gas chambers. A civil war then had restarted widespread suffering. In 1952, the good news broke of a drink, made from the root of the wild cucumber, which supposedly cured cancer. Mass hysteria swept the country, with crowds going out to uproot a weed that thrived in vacant lots and fields. Some scientists spoke out.

“A disease that is as serious, chronic and incurable as cancer gives rise to profiteers who prey on sick people seeking a cure after having been disappointed by the medical establishment,” wrote university professor Dr G Papayiannopoulos (No, I don’t know how to say his name.). The Supreme Health Council declared the consumption of the brew to be useless and even dangerous.

“It is extremely sad that the daily press has been promoting cures for cancer without any scientific basis,” said the council.

In 1955, a Thessaloniki drinks manufacturer called Georgiadis claimed to have found a drug to cure cancer. Two patients who drank the concoction died suddenly, however. Athens University’s toxicology laboratory found that the brew did not combat cancer and was a mixture of wild cucumber, strawberry essence, sugar and alcohol. Georgiadis was charged with practising medicine without a licence. (Why does this not happen in New Zealand, instead of quacks enjoying public funding?)

In 1975, a newspaper reported that a 36-year-old lawyer from the Greek Island of Kos, Giorgos Kamateros, claimed that the water of his home village cured cancer. He distributed the water in tanker trucks around Athens and in the countryside. Headlines reported daily that the water cured everything: that it had brought a mad woman to her senses, that it had restored the sight of a blind woman. Studies found no curative properties in the water, but Kamateros continued to claim that the secret lay in the minerals dissolved in the water. According to the Institute for Minerals and Mining Exploration, the minerals were simply calcium, carbon and quartz. The parents of 18 children being treated for cancer at the Aglaia Kyriakou Hospital stopped their treatment and gave them the special water. The condition of the children worsened, and one died. A few days later, the death of a cancer patient a day after drinking the water brought an end to the story. Scientists found high levels of radiation in the water. Kamateros held marches with hundreds of fervent supporters. He was charged, and the consumption of his water was banned.

In February of this year, 2007, a state television channel announced the therapeutic powers of the juice of olive leaves. Several chat shows said a thick, green drink made from olive leaves and water, mixed in a blender, was doing wonders for cancer patients. Several electrical appliance stores reported selling out of blenders. Health officials publicly warned that drinking the olive beverage could be harmful. Zoe Bazou, a member of a Athens-Piraeus cancer victims group, Keff, said patients who had tired of strong chemo-therapy treatments or been fooled by profiteers were turning to alternative medicines.

“The result is death,” she said.

Back in New Zealand, the Lake Taupo Primary Health Organisation announced in March that, starting in July, traditional Maori medicine will be funded from the public purse. The PHO has signed an agreement with Nga Ringa Whakahaere o te Iwi Maori, the national body for traditional Maori providers, who sell massages, poultices, natural medicines, spiritual healing, bath therapy and other services. “What does it matter if it makes them feel better?” said the PHO’s chief executive, Jeremy Mihaka-Dyer. Useless Chinese and Ayurvedic (Indian) medicine already waste our taxes.

The more we look, the more we find that history repeats itself, not only from time to time, but also from place to place.

Hokum Locum

Debunking debriefing

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

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

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

More on Placebos

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

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

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

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

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

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

Medical Journal of Australia Vol 179 18 Aug 2003

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

Traditional Chinese Medicine (TCM)

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

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

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

Occupational Health Delusions

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

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

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

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

More on Goji Juice

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

The ideal marriage?

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