The Irish Annals of Quackery

To quote the late Cyril Fletcher, I’m indebted to the Irish edition of the Independent newspaper for this article, which provide a perfect opportunity to examine and expose both the deceptive character of alt-med quackery and the ease with which it rook the unwary into paying over large sums of money in return for treatments that are, at best, wholly ineffective and, at worst, potentially very dangerous.

To save time and brain cell, we’ll skip over the preamble and puffery and get straight down to the serious business of debunking anecdotal ‘case studies’ cited in the article, starting with:

Catriona McCormack suffered excruciating eczema through her childhood and early teens. Doctors prescribed steroid treatments, or applied cold tar packs to reduce the inflammation. None of it worked.

“My childhood was difficult and painful because of visible debilitating eczema,” says Ms McCormack, now in her thirties.

It’s hard to believe this woman, with her blooming complexion, ever had a skin complaint…

…Ms McCormack turned to yoga, and says it helped her to clear up not only her eczema, but her asthma as well.

She became such a convert that she trained as a teacher, and is now a popular instructor in the Dublin Holistic Centre.

Eczema is a chronic form of dermatis (inflammation of the epidermis) and there are several different type of eczema, the most common being atopic, or infantile, eczema and contact dermatitis. Given that McCormack suffered ‘excruciating eczema through her childhood and teenage years’ it seems highly likely that she has the common form of atopic eczema.

Atopic eczema is an allergic disease, which is thought to have a hereditary component and is often found to run through families in conjunction with asthma.

The exact cause(s) of atopic eczema are unclear, although the hygiene hypothesis, which argues that a lack of early childhood exposure to infectious agents, symbiotic microorganisms and parasites may increase susceptibility to allergic condition by inhibiting the natural development of the immune system is gaining in credibility amongst immunologists and epidemiologists.

Eczema is an incurable but readily manageable condition with a wide variety of treatment options, some of which are better supported by empirical evidence than others.

The key things to understand here are:

a) Atopic eczema is typically at its worst during childhood but tends to be a condition that many sufferers ‘grow out of as they get older’, i.e. bouts of severe inflammation tend to become less frequent and less severe, and

b) Diet and lifestyle factors, as with many allergic condition, tend to be associated both with periods in which the condition ‘flares up’ in adults, often during periods of moderate to severe stress, and with successful management of the condition.

In Ms McCormack’s case, her interest in yoga is probably helpful, inasmuch as it helps her to relax and alleviate/minimise stress, and as taking up yoga generally goes hand-in-hand with other dietary and lifestyle changes, which are intended to lead to a healthier lifestyle generally, these plus the usual fall off in symptoms in adulthood will account for her much improved situation.

There is nothing ‘magical’ or ‘alternative’ going on here whatsoever. Ms McCormack is almost certainly reaping the benefits of a healthy diet, regular exercise and plenty of relaxation and nothing more, the kind of ‘medicine’ than any reputable doctor will happily recommend free of charge.

Moving on, we come to:

Peter Cazalet (70), from Limerick, was diagnosed with prostate cancer in 2001.

“I was told if I didn’t have an operation to remove the tumour, I’d be dead,” he recalls.

Mr Cazalet was reluctant to undergo surgery, and turned to acupuncture, meditation, herbs and an improved diet.

“I monitored things very carefully, and if they hadn’t changed I was ready for the operation,” he says.

Mr Cazalet credits much of his recovery to acupuncturist Karen Costin, who runs a practice in Ranelagh, Dublin.

“I go for regular check-ups, but now I’m all clear and enjoying life,” he says.

Prostate cancers are, sadly, a quack’s goldmine because, in a majority (two-thirds) of cases, the cancer is non-aggressive, non-invasive and develops so slowlythat the ‘sufferer’ will die of other causes long before their cancer metastases and becomes a significant threat to their health. Despite this, doctor will often recommend surgery, if the patient is otherwise in reasonably good health, as a precautionary measure because, at the present time, it is not possible to predict if and when the cancer will become aggressive.

Mr Cazalet’s case presents a couple of possibilities, one being that he may have been misdiagnosed.

Prostate cancer is commonly detected via either a digital rectal examination (DRE) or prostate-specific antigen (PSA) both of which fall some considerable way short of 100% reliability – only 25-35% of men who have a biopsy following a positive PSA test are found to have prostate cancer. A diagnosis must, therefore, be confirmed by a prostate biopsy and even this may not identify whether or not the patient has an aggressive prostate cancer.

The other possibilities, of course, are that he does have prostate cancer but that it is non-aggressive and has not progressed in the last 10 years to any noticeable extent, or even that he had cancer but that this has gone into spontaneous remission, evidence for which has been observed in the case of breast cancer.

The slightly curious element in Mr Cazalet’s account lies in his statement that ‘I monitored things very carefully, and if they hadn’t changed I was ready for the operation,’ which leave considerably uncertainty as to whether he monitored his condition with out without the assistance of a doctor. Mr Cazalet may easily be stating here that his cancer is asymptomatic and that ‘monitored’ his own condition for the more common symptoms of prostate cancer, i.e. urinary dysfunction. He does, however, state that he goes for ‘regular check-ups’ although not with whom, having attributed his continuing good health to an acupuncturist in the previous paragraph, but even if we assume that he is seeing a medical doctor it seems unlikely that the ‘regular check-ups’ he’s entail undergoing repeated biopsies, so his ‘all clear’ may be no more than an assessment based on an unreliable DRE or PSA test.

There is, of course, no credible scientific evidence for the efficacy of acupuncture, mediation, diet, herbs or meditation as a treatment for prostate cancer, or any other cancer for that matter – Mr Cazalet’s case is merely a classic example of a post-hoc fallacy.

While we’re on the same general subject – cancer – and the same acupuncturist, we can also dispense with this story…

Betty Lynch (71), from Tipperary, used Ms Costin’s services to help her get through intestinal cancer.

Ms Lynch says she suffered terribly as she had an adverse reaction to the drugs and chemotherapy needed to help her recover from the cancer.

“I was in my own private hell,” she recalls. Her doctors at the Blackrock Clinic allowed Ms Costin to come into the hospital to administer acupuncture treatment.

This is very different scenario to the first as acupuncture is being used here as a complementary ‘therapy’ to assist with the side effects of chemotherapy and not as a means of treating or managing the cancer itself.

At first sight, MS Lynch’s account is much more credible than that of Mr Cazalet.

There is evidence that acupuncture may be beneficial impact on the incidence of nausea and vomiting following chemotherapy and, better still, the evidence is to be found in a review published by the Cochrane Library.

That said, I would advise approaching even this review with a measure of caution given the somewhat curiously mixed nature of its findings:

This review looked at whether stimulating acupuncture points could reduce nausea and vomiting caused by chemotherapy. Acupuncture points can be stimulated by acupuncture applied with electricity (electroacupuncture), acupuncture without electricity (manual acupuncture), acupressure (pressing on the points usually with fingertip), or electrical stimulation on the skin surface such as wristwatch-like devices. Electroacupuncture reduced first-day vomiting, but manual acupuncture did not. Acupressure reduced first-day nausea, but was not effective on later days. Acupressure showed no benefit for vomiting. Electrical stimulation on the skin showed no benefit. All trials also gave anti-vomiting drugs, but the drugs used in the electroacupuncture trials were not the most modern drugs, so it is not known if electroacupuncture adds anything to modern drugs. Trials of electroacupuncture with modern drugs are needed.

Two things jump out at me from this study.

One is that electroacupuncture did reduce first-day vomiting but conventional manual acupuncture didn’t, a result that pretty screams ‘placebo effect’, studies of the placebo effect having long since established that the better and more sciency-looking your machine-that-goes-ping is, the more effective your placebo will be.

The other observation I have, which is not apparent from the information given in the plain language summary, is that the apparent nausea-inhibiting effects of acupressure relate specifically to self-administered acupressure and not to acupressure given by a third party. This sound suspiciously to me like the ‘toothache effect’ in which the same pain that kept you awake all night and drove to distraction turns ‘magically’ into an easily tolerated dull-ache that you’re barely aware of once you get up in the morning and go to work. The pain hasn’t of course, actually got any worse or better in either situation. What’s changed is simply that once you’re up and about, you have other things on your mind to take your attention aware from the face that really need to be getting along to a dentist.

It seems possible, if not highly likely, that this is the principle at work here and that its the very act of self-adminostering acupressure that’s making the difference by distracting the patient and taking their mind off their feelings of nausea, altering their perception of how they feel while making no actual biological difference to their condition.

At this point, its also worth noting that the other common element in both stories, a Dublin acupuncturist named Karen Costin, specialises (according to her own website) in treating infertility.

Karen’s practice predominantly involves treating infertility. She uses Acupuncture to assist women who have been diagnosed with various types of infertility, including PCOS, blocked fallopian tubes and endometriosis. One of the most common diagnosis of her client base is unexplained infertility, which can be treated very successfully with Acupuncture.

As you might well expect, Costin’s site makes any number of expansive and wholly unevidenced claims for the efficacy of acupuncture as a treatment for a wide range of fertility-related conditions but no links to actual research, while the Cochrane library gives this assessment of the current state of play:

The data from this meta-analysis suggests that acupuncture does increase the live birth rate with in vitro fertilisation (IVF) treatment when performed around the time of embryo transfer. However, this could be attributed to placebo effect and the small number of trials included in the review. Larger studies are necessary to confirm the results. Acupuncture may have potential harmful effects in early pregnancy and hence clinicians should be cautious when giving advice regarding the use of acupuncture in early pregnancy.

What I particularly like here, however, is the assertion that:

One of the most common diagnosis of her client base is unexplained infertility, which can be treated very successfully with Acupuncture.

‘Unexplained infertility’ is, for most couples, just another way of saying ‘you’ve been a bit unlucky so far but keep trying and you’ll probably get there in the end’.

However much getting pregnant might seem to be the most natural thing in the world, the reality is far more complicated. If I recall my stats correctly, the chances of a fertilised egg implanting successfully in the womb are between 1 in 6 and 1 in 12 and the risk of pregnancy spontaneously aborting within the first 3-4 weeks after conception is around 1 in 4, so taking 12-18 months to get pregnant is actually nothing out of the ordinary even if, as often happens, couples start to worry that things aren’t going to happen for them after a mere 3-6 months of the trying for a baby.

There is a very clear gap here between public perceptions of how long it ‘should’ a perfectly healthy and fertile couple to conceive and how long it can actually take without there being any underlying problems or barriers to conception and this, as ever, provides fertile ground for quacks to operate in and exploit people’s natual anxieties to their own personal benefit and material gain.

Acupuncture is not an effective treatment for actual infertility and the evidence, to date, for its use as an adjunct to IVF treatment is limited in both quality and scope.

Skipping on past the MS guy and his miracle cure books – look up the relapsing-remitting varient of multiple sclerosis for an explanation of where he’s likely to fit into the picture – we come to a special treat, one that I’ve deliberately saved until last because, unlike the other anecdotes is the article, this one appears to advocating a ‘treatment’ that may not only be useless but may actually be potentially dangerous.

But some doctors do say a more holistic approach is better for our health.

“Prevention is still better than cure,” says Dr Sam Van Eeden from the Arte Novi clinic in Malahide in north Dublin. For example, using a natural substance, he helped Brian Meyrick beat high cholesterol and avoid taking strong medication.

“I did 10 treatments and it cleared me out and got me well, no side effects, and now I’m enjoying life,” says Mr Meyrick.

The course of treatment, administered by injection, wasn’t cheap at €1,800, but it’s worth every penny says the 65-year-old.

“I worked for 40 years. I want to stick around and enjoy life and spend my few bob — I’m fecked if I’ll leave any of it behind.”

Dr Van Eeden treated Mr Meyrick using phosphatidylcholine, a natural product derived from soy. The treatment is given intravenously and focuses on removing plaque build-up that can cause stroke, heart attack or by-pass surgery.

Dr Sam Van Eeden is actually a plastic surgeon and… well, as you’ll see, things haven’t been going too well for Dr Van Eeden of late:

To the banks they could do no wrong, and lenders fell over themselves to hand over millions to the van Eedens at the height of the boom.

But after forfeiting two luxury homes in just a few months, cosmetic surgeon Sam van Eeden and his wife, Zelda, are now being pursued for a third.

The couple had splashed out extravagantly at the worst time of the property bubble – just as it popped – and had amassed luxury piles in Malahide, Co. Dublin, close to Mr van Eeden’s thriving cosmetic surgery cosmetic surgery, plastic surgery for cosmetic purposes, such as the improvement of the appearance of the face by removing wrinkles or reshaping the nose.

Yesterday, a third lender started proceedings against the pair for the recovery of an investment property in the same leafy suburb.

Obvious question – what the hell is a cosmetic surgeon doing offering alt-med ‘treatments’ for high-cholesterol at €1,800 a pop and what do these treatments actually entail.

Well, the answer is phosphatidylcholine, a chemical that is mechanically extracted from soy beans or egg yolks using hexane – anyone harbouring an untreated naturalistic fallacy should look away now – and Dr Van eeden appears to have been administering this chemical intravenously in the belief that this will help to remove excess cholesterol from their bloodstream.

So where the hell did he get the idea for this particular treatment?

Well, the use of phosphatidylcholine injections has been promoted for some time as an alternative to vacuum liposuction in the belief that it will break down fat cells in the body. Although early experiments did show some evidence of lipolisis of fat emboli, there are currently no peer-reviewed studies that show that these injections to be capable of lipolisis to anywhere near the extent of liposuction.

Yes, Dr Van Eeden is using an unproven alternative to liposuction as an intravenous treatment for high cholesterol and, for once, this is a treatment that genuinely hope does prove to be completely utterly ineffective because catlyzing phosphatidylcholin in the presence of cholesterol in the human body with an enzyme (LCAT – lecithin cholesterol acyl transferase) results in the production of hydrophobic cholesterol esters, which are much less soluble in water than free cholesterol and which typically accumulate in the fatty lesions of atherosclerotic plaques.

If I understand the chemistry correctly here then intravenous  injections of phosphatidylcholine will reduce overall levels of free cholesterol in plasma by catalysing it into cholesterol esters but it what it won’t do is actually remove the ‘plaque build-up that can cause stroke, heart attack or by-pass surgery’ – if anything it may may matters considerably worse.

i can the logic behind this ‘treatment’ but it seems to owe rather more to plumbing than it does to medicine. The phosphatidylcholine is, in effect, being used to ‘flush’ the system of cholesterol in much the same way that you’d use a caustic gel to flush a blocked waste pipe.

What I can’t see, beyond combining the treatment with a near total blood change, is quite how you remove the resulting cholesterol esters from the system after you’ve administered the ‘treatment’. I’ll freely admit that I may be missing something here and stand ready to be correct should it transpire that the body’s natural homeostatic processes will take care of the problem, but if I’m not then this looks to be a potentially dangerous ‘treatment’ for high cholesterol; one that may give the appearance of a short-term benefits – a reduced cholesterol level after treatment – but only at the expense of a significant risk of increased long term damage.

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