A good SLAPPing

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https://theconversation.edu.au/protecting-consumer-champions-from-getting-slapped-7934

Tell it like it is (part 1)

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If you suspect this is for you. Then it probably is.
More blog coming….

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60 Minutes Australia feature story on Dr. Tobinick’s treatment for Alzheimer’s Disease

I am a physician practicing Pain Medicine in Victoria, Australia. In November 2011, I published a hastily written series of off-the-cuff comments regarding the favourable feature story that 60 Minutes had broadcast examining the pioneering work of Edward Tobinick MD for patients with Alzheimer’s Disease, a story that I now realise was carefully researched and accurately depicted. I deeply regret the inaccuracies of my comments, and I wish to correct the record. I have now had the opportunity to examine the scientific literature in detail. My initial skepticism regarding Dr. Tobinick’s work was incorrect. There is, indeed, independent published scientific literature that provides a substantial scientific rationale and independent scientific support for Dr. Tobinick’s pioneering work with etanercept (Enbrel®), not just in the field of Alzheimer’s research, but also in the field of pain medicine. Any imputations to the contrary are scientifically inaccurate. As a professional skeptic it is well known to me that new ideas in science and medicine are often improperly attacked, to the detriment of scientific progress. I unreservedly apologize to both Dr. Tobinick and 60 Minutes for my inaccurate, improper, and unfortunate comments, which I have removed and regret ever having made. It was a mistake that I will endeavour not to repeat. I appreciate the opportunity to correct the record in a matter such as this of such significant public importance.

I ask any who may have read either of the articles, posted respectively on 8 and 9 November 2011, to note that the articles were or may have been defamatory of Dr Tobinick.

Signed,

Michael F. Vagg MBBS aka Mick Vagg
Fellow of the Australasian Faculty of Rehabilitation Medicine and Faculty of Pain Medicine
Clinical Senior Lecturer at Deakin University School of Medicine, Geelong
Visiting Medical Specialist to Barwon Health Pain Management Unit

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Ersatz Science, CAA-style

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Ersatz is a fantastic word which has almost dropped out of modern English. It is borrowed from German and has the meaning of a ‘replacement’ or ‘substitute’ in that language. In English it has been used in a derisory or ironic way, because of the experiences of POWs in the First World War being given ersatzbrot or ‘substitute bread’ which was made not with good quality flour but with dust, sawdust or whatever extender happened to be on hand. The term became very popular with widespread rationing during and after the Second World War. Ersatz coffee, axle grease, stockings (made from lard!) and other commodities were substituted for the real stuff which had become scarce.

 

I was reminded of all this while watching the utterly brilliant TV show Horrible Histories on ABC 3 with the kids. If you haven’t seen this show, you are mad if you don’t immediately download both series from your digital provider of choice, even if you don’t have any kids in the house. It truly is pythonesque..

 

Strangely enough, it also coincided nicely with the ‘release’ of some ‘new findings’ by the Chiropractors Association of Australia, National Branch. Regular readers of these pages will suspect what is coming next…

 

Not content with exhuming old studies with a tenuous link to the PR point that they want to make, CAA appears to have resorted to spying on schoolchildren for their next stunt. Their PR release is headed

Aussie kids risk spinal damage – observational study

Hello, thinks I to myself, maybe they mean this sort of thing…

 

Which is of course an idiopathic scoliosis. Or maybe they mean this sort of spinal damage…

Which is of course a complete spinal cord transection of the type which occurs in high-speed trauma accidents.

 

Being the CAA of course, they don’t mean this type of serious spinal damage. They are talking about kids’ school backpacks. So not actually very serious at all. Or could it be? According to the CAA spokesperson

 

Putting too much stress on a child’s back at such an important stage of growth and development will result in serious spinal problems immediately and later on in life.”

Yes, but what sort of serious problems???

 

Some of the problems caused by bad posture at an early age include reduced mobility, possible early degeneration of bones and joints, increased vulnerability to injuries and unhealthy pressures on a child’s nervous system.

So to paraphrase if your kid has too much in their school backpack, and is not strapped into it like an ejector seat, they are subject to ‘unhealthy pressures’ and ‘increased vulnerability to injuries’.

The only increased vulnerability to injury by unhealthy pressure highlighted by this so-called scientific study is me shattering my head through the top of my desk.

How was this ‘observational study’ carried out? By covert chiro operatives it seems.

‘under cover’ research from the Chiropractors’ Association of Australia reveals an alarming 75% of Australian schoolchildren do not use the ergonomic features built into their school backpacks.

 

There is more though (as if that wasn’t bad enough)

An alarming 90 per cent of school children have bad posture when carrying their bags and could experience spinal damage as a result, while 75 per cent are not using their school backpack’s ergonomic features which could prevent such damage, according to an Australian first observational chiropractic study.

They get alarmed quite easily over at CAA apparently. So, what about this groundbreaking study which clearly has significant policy implications for the Department of Health and Ageing? How well do these searing indictments on the parents of Australian schoolchildren generalize to the population at large?

 

Sadly, I can’t tell you. The PR release is clearly meant for undigested regurgitation by journalists as there is no link or reference provided to the actual ‘study’ anywhere in the piece. It does seem a bit irresponsible for CAA to be sitting on such a major finding without at least giving anyone a look at the paper. It reminds me a lot of this example of prior CAA ersatz research which was marketing research done by a PR firm and spun by the CAA as original ‘research’.

 

So I did what any responsible aspiring journo or blogger would do, and emailed the PR contact listed in the release to ask for a copy or a link to the original study so I could make a professional assessment of the findings. I have not had a response as yet to enable me to enlighten you all about the details of this study, which is apparently an Australian first if you don’t mind.

 

The thoughtfully provided Fact Sheet does tell us that 340 children were observed in the field, presumably on their way to school completely unaware they were being surveilled by the backpack stasi. Their parents were then grilled about the children and their backpacks, presumably just before being reported to child welfare agencies for stuffing the backpacks full of harmful stuff like lunchboxes, sports gear and books.

 

So there you have it. If science is scarce and difficult to produce, like it is for the sultans of subluxation, you can just produce ersatz science and try to put it over people as the real thing. Non-published, non-peer-reviewed marketing data is not science and never will be. However, if you have a product to sell, perhaps even a CAA-endorsed backpack or something like that, perhaps just the media release to scare conscientious parents is good enough.

 

 

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Introducing…Hahnemanocrates!

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A sparkling gem of altmed wooly thinking has gone widely unremarked because it came during the runup to the silly season. I felt it was worth putting out there in the context of the current debate about the teaching of quackery in universities.

 

One of the most egregious offenders in this case is Southern Cross University, based in the North Coast of New South Wales and with major campuses at Lismore, Coffs Harbour, Gold Coast and Tweed Heads. They were the first to offer degree-level training to naturopaths, with support from Marcus Blackmore, owner of Blackmore’s of CokeandfriesGate fame. Blackmore received an honorary doctorate from SCU in 2006, and was the inaugural Chair of the Southern Cross University Foundation Board. The University offers more conventional healthcare training apart from the naturopathy and osteopathy courses, with allied health disciplines including psychology, occupational therapy, exercise physiology and nursing offered as well. The Dean of the School of Health is Professor Iain Graham, an academic nurse with a very long list of publications and contributions to the literature of his profession.

 

This makes the following howler a bit hard to figure out.

 

When responding to criticism of his School’s woo-based courses, Prof Graham dropped this pearl

 

“He mentioned homeopathy for example, well homeopathy is as old as Greek Hypocrates in terms of practising medicine.”

 

The same quote bobbed up a couple of days later in the local paper.

 

Dr Steve Novella did a very good job of dissecting the logical fallacies in these brief quotes so I don’t think any more needs to be said apart from noting that if this is the level of informed comment from the academic in charge of the School, I shudder to imagine the level of teaching that goes on at an undergraduate level.

 

It did get me thinking though. What if homeopathy HAD been invented by the Greeks instead of by Samuel Hahnemann in the first decade of the nineteenth century? I know that Hippocrates (note the spelling if you read the ABC local news link above!) in 400BC described the idea of using a small dose of mandrake root (which causes delirium and disorganized behaviour in toxic doses) to treat mania. He did not make this a general rule however, and he also wrote about a bunch of other causes of disease and various cures based on other principles.

 

This leaves room for…..Hahnemanocrates. The true inventor of ancient Greek homeopathy.

 

 

So now Prof Graham can rest easy for his next interview. If he needs to quote Hahnemanocrates he now has some references…

 

 

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True Blue Woo: sCAM from the Lucky Country

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                                            Photo credit news.com.au

 

I don’t often come over all sentimental about this wide brown land of droughts and flooding rains, but as our annual orgy of self-congratulation and manufactured hype nears its peak I did think it was worth looking at what we have done for the world of sCAM. Think of it as a way of being ironic and sentimental at the same time.

 

The sCAM industry in this country is worth nearly 2 billion dollars a year of sales according to their peak industrial body, the CHCA, but what I’m really interested in is which products or treatments have Australians created?

 

Being from Geelong I’m queasily proud to open the conversation with our local sCAM modality – Bowen Therapy. Tom Bowen was a football trainer with a huge local reputation for his manual treatments. Bowen came up with an idiosyncratic set of beliefs and teachings about fascia and its effects on health, which were eventually formulated into Bowen Therapy. He died in 1982, and his treatment lives on through the Bowen Therapists Federation of Australia founded in 1998. Amusingly, there have been some attempts to cash in by others as evidenced by this little article which seems to be trying to rebrand the technique as a proprietary therapy called Bowenwork(TM). Their literature review sets the fairly low hurdle of including studies which a.’referenced the original Bowenwork’ ,b. provided ‘health-related outcomes’ and c.provided quantitative or qualitative data. So really, that seems like the absolute minimum you would need to even think about sending a paper off to even a crappy journal for consideration. One wonders what studies there could be that provide no health-related outcomes or used non-quantitative data (if that’s even a thing). Fortunately that knocked out almost all of the 309 citations they found in the literature! Of the 15 that were left, there was only one solitary RCT. 7 of them were just case reports. To paraphrase Abraham Lincoln, this evidence is as thin as the homeopathic soup made from boiling the shadow of a chicken which had starved itself to death. Can you guess the conclusion? Yep, you probably can.

Further research is needed to systematically test this modality, before widespread recommendations can be given.

So despite the fact that there are national and international organizations dedicated to this therapy, the best available systematic review cannot conclude after at least 50 years of being practised, there is no credible evidence to support its use.

 

I have previously documented the work of Neil Davies in establishing paediatric chiropractic as a separate field of endeavour (even a personal fiefdom)  in the UK and Australia, and I’m too embarrassed to go over it again. Sorry world, for that one.

 

On a brighter note, we also gave the world the Alexander Technique

My adorable other half for many years had aspirations of a serious acting career, so I encountered this highly systematized and idiosyncratic series of exercises and anatomical teachings while still a dewy-eyed medical student. It was invented by a Tasmanian living Melbourne in the early part of the twentieth century. FH Alexander by his own account was a second-rate Shakespearean actor who tended to lose his voice on stage due to vocal cord fatigue. He made the astute observation that babies and toddlers could cry loudly for hours without losing their voices (I can personally vouch for the truth of this observation) and reasoned that adults should be able to as well. Much in the same way as Joseph Pilates developed a routine for targeting the core abdominal muscles, Alexander did the same for the muscles of the head and neck. The results were so impressive that actors ever since have paid serious coin to undergo the gruelling training to learn how to move according to Alexander’s precepts. The distinctive sinuous movements and beautifully erect postures of serious stage actors are pure Alexander Technique. Proponents of the technique do not make huge health-related claims, but you could see how it could be used as a way of trying to normalize the protective movement patterns of chronic pain patients to name just one group. A 2008 study published in BMJsuggested that it could be a cost-effective way of helping back pain patients in a GP setting. So I will accept Alexander Technique as a plausible but still underevidenced modality for back pain, and a very helpful way for actors to look and sound good on stage.

 

Another proudly Aussie bit of woo is Goanna Oil. I can’t be really critical though, as Goanna Oil has never made claims beyond being a rub-on salve, and just looking at the bottle gives me traumatic flashbacks to my high-school athletics career. The company website has a great history and some fantastic graphics of the old advertising for Goanna Oil products. It did indeed originally contain goanna fat rendered into an oil with other stuff added to it, but since goannas became a protected species in the 1960s they have not used any indigenous animal-derived ingredients.

 

Across the ditch in New Zealand they have cornered the market in deer antler velvet. Fortunately it seems that the deer don’t come to any actual harm, but I have to say between that and the green-lipped mussel the Kiwis seem to have a fetish for weird animal bits to get their arthritis relief. If I was the Slimy Weird-Arsed Tree Frog native to NZ, I’d be holding tight to my goolies in case any altmedders came looking for me….

 

More concerning is Elmore Oil(TM), a proprietary blend of olive oil, eucalyptus oil, melaleuca oil and vanilla extract. The name comes from the town of Elmore in northern Victoria where the inventor of the product lived. The Elmore Oil website is a classic alt med combination of weasel words, obfuscation, ‘sciencey’ explanations and outright prohibited claims. I was able to find several very questionable claims in just a few minutes of browsing including the familiar tropes

 

Elmore Oil is supported by science at all levels.

The creation of Elmore Oil is founded on strong scientific data compiled over a number of years by leading Australian and international researchers. Vast amounts of clinical data go to support the methodology of the Elmore Oil formulation at every level.

Nuh. Not strong. Not vast. Not at any level.

 

Elmore Oil is a proven pain reliever and anti inflammatory, which makes it one of the very best options to treat recurring arthritis pain,

Not proven. Not one of the best options for recurring arthritis pain. Not according to any scientific evidence they put forward. I see no head-to-head trials or any other comparative data.

 

There are testimonials (not legal unless they are typical and unremarkable) and they make a ludicrous and wholly unsupported claim about getting to sleep

 

The key to improving your sleep patterns is to apply a small amount of Elmore Oil to the soles of your feet just before going to bed. This is the fastest entry point to the body for essential oils, and the oil will go to work fast taking away those little aches and pains you may not have even been aware of, that are preventing you from a great nights sleep. If you have a specific chronic pain you can aslo apply directly to this area as well, (neck, back etc) but the most important thing is to apply it to the soles of the feet.

I have only one response to that.

 

So happy Aussie day guys and when you’re reaching for the empty KFC bucket to dump your lunch because channel 9 wants you to meet just one more fecking ‘true blue Aussie hero’ you can think of Elmore Oil and Bowen Therapy and be proud that these lame-arse woo therapies are the best we can do.

 

You’re welcome, world.

 

 

 

 

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Chiropractic: Breaking News from 1999

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Remember 1999? The big news that year was Bill Clinton surviving impeachment proceedings, the introduction of the Euro as a world currency and the world couldn’t get enough of the debut singles from new artists like Britney Spears and Lou Bega (at least one of whom was heard from again). Sorry Lou, Mambo No 5 was as good as it got.

 

Well, in another stunning and groundbreaking press release, the Chiropractors Association of Australia has dredged up a paper from 1999 and produced a breathless PR factoid from it.

 

As the Federal Government moves to enforce plain packaging for all cigarettes, the Chiropractors’ Association of Australia is highlighting yet another good reason to give up the cigs with research1 indicating a link between smoking and poor spinal health.

So let me see if I’ve got this right. There is a political push towards plain packaging for cigarettes. The CAA is trying to claim that it is an evidence-based organization, and distance itself in the public mind from some of its more embarrassing positions, especially its support for predatory business practices by chiropractors (which the chiropractic AHPRA Board is trying to stamp out) and its “now-you-see-it-now-you-don’t” non-policy on immunization.

 

So it makes complete sense for the CAA to come up with a science-based comment about plain cigarette packaging and back pain, which is the last fig-leaf of possible evidence-based raison d’etre for chiropractic types.

 

But the clownshoes begin to be visible from about this point on.

 

The study that the CAA release is apparently ‘revealing’ is given here as

Scott, S.C. et al. (1999).The Association Between Cigarette Smoking and Back Pain in Adults. Spine 24 (11), 1090-1099

The abstract can be found here

A few things are noteworthy. Firstly, this was a postal survey by a team of epidemiologists. It was not a chiropractic study and therefore one wonders why the CAA is trying to give the impression that it is ‘revealing’ a previously unknown phenomenon. Secondly, the study design was very weak, in that the populations selected for the questionnaires were unusual (half the participants had idiopathic adolescent scoliosis, and the male:female ratios were very skewed towards females, as IAS is a predominantly female condition). The findings of such a study are certainly not generalizable to the population at large, and indeed, the authors are too savvy to claim that. It is only the CAA who are using the study as a cherry-picked example from the literature to further their PR ends who are making this claim.

 

There is a huge literature on the relationship between smoking and back pain. None of it backs up the next barrage of drivel from the new CAA Prez.

I will quote it in full, as I don’t want to take it out of context.

“You often find that people who smoke have decreased muscle tone, especially in their mid-40s and beyond, depleting the entire structure of the body,” Dr Tassel said.
“The fact is smoking reduces lung function, and healthy lungs are needed to allow for optimal exercise.
“When smokers reduce their exercise levels they also reduce their muscle strength and body structure leaving the whole body’s level of health depleted and susceptible to injury.
“Put simply, less exercise causes weak muscles, weak body structures and spinal pain,” Dr Tassel said.

First he moves from bizarre generalization to tenuous quasi-scientific speculation, and follows up with a somewhat tepid and confused punchline at the end.

 

If I follow Tassel’s argument, he is saying something about lack of exercise causing muscles to waste and therefore…….nuh, I still can’t see how this relates either to smokers having more back pain or indeed, the original reason for the press release, which was plain packaging on cigarettes.

 

This really is a less-than-stellar effort from the new CAA honcho. Although they have increased their spend on lobbyists and advertising, the CAA still has a long way to go to be in any way relevant or convincing.

 

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The Fishslapper Guide to….’Digestive problems’

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With the festive season upon us, and feats of gluttony that would boggle mind and roll back the eyes being perpetrated at parties and gatherings around the nation, it seems like a good time to dive back into the wunnerful wurld of woo with a probe into the brown and murky depths of what is euphemistically called ‘digestive health’.

 

First up…diarrhoea. Where else does one turn for secret knowledge about natural health than secretsofnaturalhealth.com ? Intriguingly, it seems our host Dr Singha is of the opinion loose bowel actions involve the lungs, liver and colon. One out of three ain’t bad I suppose. If you name internal organs at random you are bound to end up with some that are relevant. I’d have thought ones in the abdomen rather than the chest might be more plausible candidates. Displaying the dangerous simplicity at the core of most alt.med, Dr Singha opines that

Diarrhoea is nature’s way of getting rid of food which your system has reacted to. It is therefore a cure rather than an illness.

I’m sure he might at least consider rotavirus an ‘illness’ rather than a ‘cure’ given that it kills 435,000 children every year.

The most unintentionally ironic ‘natural treatment’ for diarrhoea belongs to these guys.  Using Rice Water to treat diarrhoea is simply rehydration therapy, as they themselves almost acknowledge.

And why rice water instead of rice to stop diarrhea? Probably because in water or soup form, the “essence” of the rice is more readily absorbed. In Chinese medicine, a lot of remedies are taken in the form of soups and herbal brews.

Not really. Water prevents dehydration, rice does not. The carbohydrates in the rice water may have an osmotic effect which may reduce the severity of the diarrhoea, but it gets better anyway as most cases are self-limiting. It really is nothing at all to do with the essence of rice. I do however agree with them that

diarrhea can be considered to have expanding / downward / rapid energy.

Expanding downward rapidly is right, especially during norovirus season (spring) which is drawing to a close here in Australia.

 

Next up……constipation.

If you were just sitting there in the long interval between bowel movements fiddling around trying to spend your time wisely, you would naturally type www.overcomeconstipation.com into your browser and straight away you’d be transported to a world where even your colonic peristalsis has political and social ramifications.

Good ole Vitamin C gets a run, as do the usual suspects of foods with skins made of indigestible starches, eg dates, prunes, sultanas etc. I am intrigued by their mention of yoga as a good treatment for constipation. Apparently

The yoga poses squeeze the body parts in certain manner which relieve tension and make the digestive organs work more efficiently and improve digestion and elimination.

This gives me a horrid mental image which I can’t quite unsee. I hope the yoga mats they recommend are easily cleanable. Further down the same page I came across a paragraph so hard to understand I’m quoting it in full.

5. Controlling Old Cough – Although this is not very common, many naturopaths also emphasize a lot on elimination of old cough.  The reason for this is old cough stick to the intestines and gradually the feces also start sticking to the intestinal walls which can cause water loss in the intestines and chronic constipation.

I was once told that Guinness ‘sticks to ya ribs’ but I cannot fathom exactly what ‘Old Cough’ is and why it should stick to anything at all, let alone the intestines. O_o all round. I do love the little matter-of-fact anti-pharma rant at the start especially. Makes having an enema seem like stickin’ it to da man. #OccupyMyColon anyone?

 

Thanks to all regular (and casual) readers. Have a great break and see youse all next year, when we will have only until the 21st of December to mend our unhealthy ways…or something.

And as a final treat, to help with your ‘digestive health’ here is a piccy of the Bristol Stool Chart which all doctors have to learn by heart

 

 

 

 

 

Placebo Band a potential threat! (also Rhys Morgan is AWESOME)

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While 17 year old Rhys Morgan takes on threats, legal and otherwise, it’s made his mum a bit paranoid. Perhaps Hayley Stevens should have put a return address on the Placebo Band she sent him. Read about the tomfoolery on the Guardians web page here

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Taking a break

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With the holiday season approaching quickly, and to avoid any misunderstandings or disappointments, we have decided to shut down the placebo band store for a few weeks.

Don’t panic though, I’ll do a stock take and have the store back up around mid January. If you are super keen and need to get a hold of us, just send an email to skepticbros(at)skepticbros.com and we will try to take care of you.

Or if you are in North America please go to placebobandstore.com for all your Placebo Band needs!

If you are after a magical idea for a gift and have missed out on ordering a placebo band on time, you could always try giving that special someone a Unicorn Horn ?!?!?

This is just so we can have the chance to recharge our skeptical battery’s and possibly spend a little more time with our families around the end of the year.

We will try to put up a few more blog posts to kinda make up for it…

So anyway in the mean time we will be taking road trips…

 

 

 

 

 

 

 

 

 

Getting dressed up…

 

 

 

 

 

 

 

 

 

 

 

 

And gathering around a tree to celebrate Woden, Bacchus, Jesus, Adonia, some sort of resurrection or just the wonderful nature of the evergreen tree (or in our case super fantastic electric tree)…

 

 

 

 

 

 

 

 

 

 

 

 

Happy thinggy everyone!

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