Home Blog Page 81

Brazil’s bogus “Covid kit” represents a failure of private healthcare regulation

Natália Pasternak
-
0
Brazil’s bogus “Covid kit” represents a failure of private healthcare regulation

The COVID-19 pandemic has brought to light social and economic issues that were previously hidden under the carpet. This has been the case all around the world, but it goes a step further in Brazil. Not only has the pandemic highlighted our social inequalities, it has made us painfully aware of how unprepared our young doctors are when they leave medical school, and how susceptible they are to magical thinking and miracle cures.

Brazil has both public and private healthcare systems. While we are very proud of our public healthcare, it is overwhelmed and underfunded, so those who can afford it often go for a private healthcare plan, which works like an insurance system. This column has already denounced the use of hydroxychloroquine (HCQ) in Brazil, promoted by the Ministry of Health and the federal government. Throughout the pandemic, even more miracle cures were added to the list, and in September the Ministry of Health came up with the “Covid kit”, dubbed the “early treatment protocol”.

The kit includes not only HCQ, but other unproven or useless medications, such as nitazoxanide (a deworming medication), ivermectin (for getting rid of lice), azithromycin (an antibiotic), vitamins C and D, zinc, heparin (for blood clotting) and corticosteroids. Flutamide, a prostate cancer medication, was the last addition to the kit. They are not always prescribed all together, but usually you get at least 5 or 6 of them in a single prescription.

My NGO, Instituto Questão de Ciência, together with a health workers union, tried to file a complaint with the Supreme Court in May 2020, over the use of HCQ. We haven’t heard from the Supreme Court so far – perhaps they have more pressing issues than people dying. While we were fighting both the federal government and the Federal Board of Medicine (the latter of whom defended the right of doctors to be free to prescribe whatever they deem fit), the private healthcare sector was also pushing the “Covid kit”, to an extent that was troublesome to say the least.

Hapvida, Unimed, and Prevent Senior are large private healthcare companies in Brazil, the latter catering to senior citizens only. According to El País, they have been prescribing the Covid kit to anyone who shows up with flu-like symptoms, regardless of the symptom, without even examining them properly or interviewing them to learn about comorbidities and other medications they might be taking.

El País shows several stories of patients who reported mild flu-like symptoms, some which were little more than a headache, and were given a Covid kit. Some received the kit by post, with no consultation and no testing. Sometimes, a “consent form” would follow. Some patients told the newspaper that nobody took their health history, even though one patient was diabetic, and another had a heart condition. The irregularities keep coming. Antibiotics in Brazil can only be sold or distributed by prescription, to prevent the development or multi-resistant bacteria. Microbial stewardship demands that antibiotics are prescribed with care. Nonetheless, these healthcare plans are encouraging their teams to prescribe it broadly – a policy which could bring about dire consequences, and even cause another public health crisis.

Encouraging, by the way, may not be the correct way to put it. Brazil’s largest TV station, Globo, showed how Prevent Senior was forcing its doctors to prescribe the Covid kit. Afraid of losing their jobs, many did. Some were brave enough to come forward, under the promise of anonymity. They said that there was huge pressure from the supervisors to prescribe these drugs, even though they are unproven – and in some cases disproven – for Covid, and what is worse, they are not without harm.

White tablets sitting on top of a nettle leaf

The combination of these drugs can affect liver and kidney functions, and there have been cases of death for liver failure, while many others are queuing for an organ transplant. Otherwise healthy people were given medications that they didn’t need, and now will have to undergo surgery. So much for the “what’s the harm?” argument, so common in alternative medicine, which was so frequently used to justify these phony Covid treatments.

Also impressive was how inexperienced and immature the doctors who gave the statements sounded. Brave as they were for coming forward, one couldn’t help to notice that they didn’t seem to be aware of the consequences of their actions. While everyone understands that they were afraid of losing their jobs, it is nevertheless unacceptable for a doctor to prescribe drugs that they know can harm the patient. In my opinion, it’s almost as if these doctors were incapable of connecting cause and effect. In one of the statements, one doctor says that the hospital made him work after testing positive for Covid. He knew he could infect people, and yet he obeyed.

The fact that so many doctors were prescribing miracle cures had already brought to our attention how ill-prepared our young doctors are, and how badly we need to teach critical thinking and evidence-based medicine in our medical schools. This recent episode makes me wonder if we should add ethics and common sense to the list, too. My Institute has heavily criticized the fact that both homeopathy and acupuncture are recognized as medical specialties in Brazil, and as such, are taught in our medical schools. The Federal Board of Medicine not only allows it but endorses and promotes it. It is no wonder our medical students believe in magic.

To boot, now private companies in Southern Brazil are distributing the Covid kit to their employees. One of them, Tecnocuba, a producer of stainless steel pieces, says that it was the board’s decision, based on a talk given by a local doctor. The doctor gave a talk about what she called ‘chemoprophylaxis’, and made a deal with the company, who decided to pay for consultations for all their employees, so she could prescribe them the Covid kit.

Besides being wildly unethical for a doctor to be signing prescriptions wholesale, the company’s employees may well have found themselves in a very difficult situation. What if they refused the consultation or the kit? Would they be risking losing their jobs?

Medical and scientific societies in Brazil have clarified, repeatedly, that the “early treatment protocol” doesn’t work, and can actually harm people. These drugs, especially in combination, can cause liver damage, retinopathy, and cardiac toxicity. Depending on pre-existing medical conditions, effects can be even worse. The Federal Board of Medicine insists on keeping quiet, saying that its mission is to preserve the “doctor’s freedom to prescribe”.

The result of all of this is that the practice of medicine in Brazil is presently effectively unregulated. Malpractice would usually be reported to the medical boards, but if the Federal Board agrees with this nonsense and doesn’t see any reason to regulate it, we have no choice but to appeal to the courts. Doing so, as with our HCQ case, will take much longer – and, all the while, people are dying, both from Covid and from these “early treatments”. Without effective regulation, we can only watch while bad science and bad medicine add more corpses to the pile.

What links the Flatwoods Monster, the Kelly–Hopkinsville alien encounter, and Mothman?

David Mountain
-
0
What links the Flatwoods Monster, the Kelly–Hopkinsville alien encounter, and Mothman?

On the evening of 12th September, 1952, a group of boys were playing football in the village of Flatwoods, West Virginia, when they noticed a bright light flare across the sky and appear to land on a nearby hill. Climbing the hill, they were terrified to discover an otherworldly creature staring at them. Standing between seven and twelve feet tall, it wore some sort of green cloak, out of which emerged spindly, claw-like hands. Worst of all were the burning red eyes, glaring at the children from under a black cowl. With an unearthly hiss the creature began to glide towards them. The witnesses ran for their lives, and soon the whole world knew of their encounter with the Flatwoods Monster.

Just three years later, on 21st August 1955, a similarly bizarre incident occurred 400 miles away outside the town of Hopkinsville, Kentucky. A gathering of family and friends were enjoying an evening meal when one of them noticed yet another bright light streaking across the sky. Soon afterwards their home came under attack from small, aggressive creatures. These were the archetypal little green men: just three feet tall, their bulbous heads sported pointy ears and bulging yellow eyes; their bodies were stocky and neckless, but their long arms ended in grasping, talon-like hands. Fearing for their safety, some of the group shot at the creatures, but they appeared impervious to bullets. Indeed, they seemed to toy with the humans, flipping and floating through the air with mocking agility. The family raced to the Hopkinsville police station for backup, but by the time they returned with the police the mysterious assailants were nowhere to be seen.

An equally terrifying event took place near the town of Point Pleasant, West Virginia, on 15th November 1966. Late that evening, two young couples were driving through the woods outside the town when they noticed a large, shambling figure with bright red eyes at the side of the road. Horrified, they sped away from the creature, but it unfolded an enormous pair of wings and chased them. Eventually managing to outpace it, the witnesses drove straight to police station to report their experience. Similar sightings soon began pouring in. The legend of the Mothman was born.

These three encounters have become some of the most iconic and influential episodes in cryptozoology and ufology, inspiring heated debate among believers to this day. I’m not going to try to debunk them here – that job’s already been done, thanks to detailed investigations by Joe Nickell, Renaud Leclet and others. So what unearthly creatures had these terrified people really encountered in 1952, 1955 and 1966?

Owls.

Sometimes in sceptical enquiry, the explanations are just as intriguing as the mysteries.

The trouble with owls

Let’s start with the Flatwoods Monster. The suggestion that this being was in fact an owl was raised by Air Force investigators just weeks after the incident took place. Joe Nickell explored this idea further in 2000, concluding that a female barn owl was the most likely identity of the monster. The bird, he posited, was perched seven to twelve feet off the ground, giving the impression of great height, while the long green cloak was merely foliage beneath the perch. The claw-like hands were talons, the black cowl was an illusion caused by the barn owl’s distinctive heart-shaped face, and the burning red glare was simply the result of the animal’s reflective eyes, which shine back light sources – such as the witnesses’ torches – with an eerie red glow.

An eagle owl looking directly into the camera with orange eyes and tufted ears

French researcher Renaud Leclet reached a similar conclusion when he examined the Hopkinsville siege in 2001. The culprit this time was identified as an aggressive pair of great horned owls. These large birds stand about two feet tall, possess bright yellow eyes and distinctive ear tufts – the eponymoushorns – that could be confused for the aliens’ large, pointy ears. (The ‘talon-like’ hands were, unsurprisingly, talons.) Like the Hopkinsville aliens, great horned owls also possess the aerial agility to appear to flip and float in the air. Unlike the extraterrestrials, however, owls aren’t known for their bulletproof properties. Nevertheless, I can imagine that trying to shoot a pair of owls in the dark, in a house with no electric lights, while fearing for my family’s life, might be easier said than done.

And the Mothman? It seems some residents of Point Pleasant may have figured this out back in 1966: two other witnesses who saw the creature that year were clear that ‘it was definitely a bird.’ Joe Nickell has once again investigated these sightings, concluding that a barred owl – a common animal in the woods around the town – was probably what the young couples actually saw that November night. The barred owl’s large size and almost four-foot wingspan could, in the eyes of frightened witnesses, easily be magnified into Mothman’s monstrous dimensions, and its highly reflective eyes would explain the creature’s crimson stare.

As satisfying as these explanations are, they leave one niggling question unanswered: why owls? What is it about these seemingly innocuous creatures that drives terror into the hearts of men, women and children – not just once, but again and again?

The first thing to consider is that most owls – including all the species involved in these cases – are nocturnal or crepuscular, meaning that people are most likely to encounter them late in the evening or at night. This is significant: not only do poor light conditions make it harder to correctly identify what we’re looking at; they make it more likely that we’ll misidentify it. Darkness heightens fear and distorts perception. Our brains, after aeons of evolutionary adaptation, find it safer to exaggerate potential threats when we can’t rely on our vision to tell us what’s out there. Remember that the Flatwoods Monster and the Hopkinsville aliens both emerged at dusk, and that the Mothman made his appearance by the side of a dark road. In those situations, most of us would have overestimated the danger posed by something moving in the trees. Had I been part of the Flatwoods expedition that foggy September night, would I have bolted back home with the other witnesses? Absolutely.

By itself, however, nocturnal behaviour doesn’t entirely explain the trouble with owls. After all, plenty of other creatures are nocturnal, and yet I don’t remember any instances of people confusing moths, bats and foxes for interstellar monsters. So what other features of owl biology might be at work here?

Vocalisations could play a part. Owls are remarkable creatures, but they’re not the most tuneful of birds. Besides the mournful hoots familiar to most of us, these animals also make an unpleasant array of hisses, screams and shrieks. The hair-raising cries of the spot-bellied eagle owl, which sound unnervingly like a screaming woman, are thought to have given rise to the legend of the Sri Lankan devil bird, a demon said to bring death and disaster to those unfortunate enough to hear it.

Such unfamiliar and unsettling sounds may have heightened the horror of the three American owl encounters. Witnesses reported that the Flatwoods Monster uttered ‘something between a hiss and a high-pitched squeal,’ which tallies perfectly with the frankly disturbing noises made by the barn owl. The Mothman was similarly described as ‘squeak[ing] like a big mouse,’ which – while not exactly bone-chilling – would nevertheless have been disconcerting given the situation the young couples found themselves in.

Perhaps the most important clue to consider, however, is also the most distinctive feature of owls: their broad, flat faces and forward-facing eyes. Most birds – indeed, most animals – have eyes on either side of their head, which gives them a wide field of vision in which to spot approaching predators. The forward-facing eyes of owls, on the other hand, give them finely-tuned depth perception for hunting prey. It’s a trait shared only by other birds of prey, mammalian carnivores and primates – including us.

Why is this relevant? Because human brains, in addition to being wary of the dark, are always looking for human faces. It’s our old friend pareidolia once again: the brains’ willingness – desperation, almost – to find patterns where there are none, from Jesus in pancakes to blobsquatches in bushes. Seen in poor light, and in unsettling circumstances, an owl’s forward-facing eyes can trick us into thinking that the thing we’re looking at – or, perhaps more to the point, the thing looking at us – isn’t an animal, but a human-like being, whether a bestial monster like the Mothman or the manikin aliens of Hopkinsville. The owl’s vaguely human-looking face likely goes a long way to explaining why these birds have spawned more humanoid cryptid sightings than any other animal, with the possible exception of another animal with forward-facing eyes, the bear.

But if these monsters and aliens were simply misidentified owls, how do we explain their aggressive behaviour? Barn owls don’t normally advance on frightened children; barred owls rarely chase speeding cars, and great horned owls aren’t known for laying siege to houses.

An owl flying across some grass with a large wingspan and eyes looking forwards.

Perhaps labelling these behaviours as aggressive, however, is to look at these situations the wrong way round: what if the owls weren’t being offensive, but defensive? Both Nickell and Leclet have suggested that the Flatwoods barn owl and the Hopkinsville great horned owls might have been rearing chicks at the time of their respective encounters, and would therefore have been especially keen to keep intruding humans away. (As someone who’s been dive-bombed for inadvertently straying too close to a bird nest I find this very easy to believe.) It’s true that barred owls are unlikely to be rearing young in November, when the Mothman was sighted, but remember that the Point Pleasant creature merely flew in the same direction as the witnesses’ car for a short while. When considered from the safety of our own homes, in the sanity of daylight, it hardly seems the act of an aggressive man-beast.

Ultimately, the trouble with owls comes down to our own ignorance of these fascinating animals. If familiarity breeds contempt, then unfamiliarity spawns monsters. Had an ornithologist been among the witnesses on those three fateful nights, chances are there would have been no misidentifications and thus no tales of close encounters. As it stands, though, most of us lack the experience and expertise to keep a cool head when faced with a pair of burning red eyes and a blood-curdling scream. It seems likely that the owl’s unique combination of traits – its nocturnal lifestyle, strange vocalisations, forward-facing eyes and a willingness to defend its young – will be the source of many more monster sightings to come.

Romance in the stones? The power of crystals vs the power of suggestion

Chris French
-
0
Romance in the stones? The power of crystals vs the power of suggestion

Although I managed to publish a fair few scientific papers over the four decades or so of my academic career, I truly regret that there were a few studies that, despite producing interesting and publishable findings, I simply never found the time to see through to the final stage. In some cases, although I presented the results at conferences and even had fairly positive feedback from reviewers for more detailed versions that I submitted to academic journals, I never managed to get them over the line to publication purely because of pressure from other commitments.

Amongst those at the top of the list would be a pair of studies of so-called ‘crystal power’ that I carried out with a couple of very able final year students. As readers will be aware, belief in crystal power is prevalent amongst New Agers. It is believed that different crystals have different healing properties attributed to the so-called ‘subtle energy’ that they allegedly emit. The ‘subtle energies’ referred to are indeed so subtle that no one has ever actually been able to measure them scientifically. That makes them more subtle than the Higgs boson and gravitational waves – so, as you can see, they are very, very subtle indeed.

Despite the elusiveness of these subtle energies, it is claimed that crystals can be used to treat a wide range of medical complaints including degenerative diseases, infections, fertility problems, cancer, leukaemia, strokes, depression – in fact, pretty much any medical problem. Not only that, they can also apparently be used to enhance a wide range of abilities including creativity, sexual performance, telepathy, time travel, communication with spirits, and interdimensional travel, to name but a few.

The first investigation of crystal power that I carried out was in collaboration with Lynn Williams and the results were presented at the Sixth European Congress of Psychology in Rome in July 1999. Lynn had informally observed that those selling crystals at psychic fairs and similar events sometimes encourage potential buyers to “feel the energy” of the crystals for themselves, telling them that when they hold the crystal they might feel sensations such as tingling, warmth, improvements in mood, and so on. Many people do indeed report such sensations. Is this evidence that crystals really are emitting some kind of energy? Or are we witnessing nothing more than the power of suggestion at work? That was what we wanted to find out.

An obsidian crystal on a white background

Without going into the full details, the basic idea behind the study was quite simple. We would get 80 volunteers to simply relax for five minutes holding the crystal, with half of them having been previously primed by getting them to read a brief Introduction to Crystals that explicitly mentioned some of the sensations that they might experience as they held the crystal. Following their brief ‘meditation’ we got all participants to indicate which, if any, of six mildly anomalous sensations they had actually experienced and how strongly they had felt them. From these data, we calculated a ‘sensations index’. We also measured their level of paranormal belief. We found that the vast majority of our volunteers reported at least one of the sensations listed and several reported experiencing some of the sensations quite strongly.

Furthermore, scores on the sensation index correlated with levels of paranormal belief, as we had expected. The group who were explicitly primed had higher scores on the sensations index in comparison to those who were not primed. Oh, and it did not make any difference to scores on the sensations index whether the volunteers were handling a genuine quartz crystal or a fake crystal made of glass, identical in appearance to a real one. In other words, our results strongly supported the idea that any sensations reported were down to the power of suggestion as opposed to any ‘subtle energy’ being emitted by the real crystal.

For our follow-up study, we used an improved double-blind methodology and data were collected by Hayley O’Donnell. Results of this study were presented to the British Psychological Society Centenary Annual Conference in Glasgow in March 2001. The design of the study was essentially the same as the original study with the major addition that we also assessed each of our 80 new volunteers for hypnotic susceptibility following their participation in the ‘meditation’ phase of the study. Hypnotic susceptibility is known to also be a good measure of suggestibility in the normal waking state. Once again, the vast majority of our volunteers reported at least one anomalous sensation but, for reasons that are still not entirely clear, this time scores on the sensations index were similar regardless of whether the volunteers were explicitly primed or not. Importantly, however, scores on the sensations index correlated with levels of paranormal belief but were not affected by the real vs fake status of the crystals.

Finally, as expected, scores on the sensations index correlated with scores on the measure of hypnotic susceptibility. Once again, our results indicated that no subtle energy was emitted from the real crystal and strongly supported the idea that the sensations reported were entirely due to the power of suggestion.

Why do I regret not getting around to publishing these studies in a peer-reviewed journal so much? Because over the years, I have had to field questions from many journalists on the topic of crystal healing whenever, for whatever reason, this becomes a relatively hot topic in the news. For example, the media appears to have a fixation on the huge number of celebrities that buy into the idea – including Adele, the Beckhams (Victoria is “a very spiritual person”), Katy Perry, Naomi Campbell, and Andy Warhol.

More recently, much negative coverage of the crystal industry has arisen, leading Eva Wiseman to ask, “Are crystals the new blood diamonds?”. In her words:

“Much like diamonds, crystal mining is an industry buried in conflict. There are issues around sustainability: crystals are a non-renewable resource. There are issues around labour: most jobs are low paid, unsafe, and sometimes performed by underage workers. And there is an issue around accountability: the industry is unregulated, allowing exploitation to go unchecked.”

The reason that I have fielded so many questions from journalists and broadcasters over the years is simply because they cannot find any other empirical work on the psychology of belief in crystal power and so are forced to rely on reports of a pair of studies carried out over two decades ago, the results of which have only ever been formally presented at conferences. This is perhaps surprising given that the crystal industry is estimated to be worth billions of dollars worldwide and, as stated, is mired in controversy on various fronts. It appears that the alleged healing properties of crystals are seen by the wider scientific community to be so ludicrous that none of them, as far as I can see, have ever been put to the empirical test. In the interests of consumer protection, I would say that is unfortunate.

Crystal Healing: The Science and Psychology Behind What Works, What Doesn’t, and Why. Book cover with crystals at the top and science glassware at the bottom.

Reading Crystal Healing: The Science and Psychology Behind What Works, What Doesn’t, and Why by Dan R. Lynch and Julie A. Kirsch would go a long way to correcting many of the myths relating to the topic as well as increasing awareness of the murkier side of various aspects of the crystal industry. This husband-and-wife duo really are the dream team for authoring a book such as this. He has the expertise in geology, having already written over a dozen books on rocks and minerals. She has the relevant expertise in health psychology. Between them, they have produced an accessible guide that covers all aspects of this fascinating subject. The book is beautifully illustrated throughout and very reasonably priced.

I hope this book sells well so that as many people as possible can benefit from the gems of wisdom it contains (pun totally intended). But I fear it may not. The kind of person who might consider buying a book on crystal healing is much more likely to be a victim of uncritical New Age thinking than a scientifically minded searcher after truth. The authors and publishers are clearly aware of this as there is little on the front or back cover to indicate that this book is rightly sceptical of the overblown claims made in the name of crystal healing. Their approach is pretty obvious, however, as soon as one begins to read but potential sceptical readers may never get that far. The more woo-minded reader may well get that far but no further as they would probably prefer the usual collection of unsubstantiated claims to be found in most books on the subject. To my mind, the ideal reader of this book would be an older child or younger adult who is just starting to develop an interest in crystals but whose mind has not yet been poisoned by exposure to too much woo. Prebunking is the order of the day. But it would also make a valuable addition to any sceptic’s bookshelf, so please consider getting a copy.

Inevitably, I have a couple of minor quibbles. For example, I would take issue with some of the points made regarding the nature of science and pseudoscience. Also, it looks like the authors relied on descriptions of our own studies of crystal power in secondary sources. In particular, our fakes were not “cheap plastic crystals” as had been previously wrongly reported in at least one newspaper report – they were expertly made glass fakes that virtually everyone would have struggled to distinguish from the real thing. But I am happy to say that the positive features of this book vastly outweigh any minor negative aspects.

Crystal Healing: The Science and Psychology Behind What Works, What Doesn’t, and Why. By Dan R. Lynch & Julie A. Kirsch, PhD. Adventure Publications: Cambridge, MN, 2021. ISBN: 978-1-59193-917-7. Paperback, £13.66 (Publication date: 22 April 2021).

Despite the media reporting, the ‘dog suicide bridge’ is just an urban legend

Brian Eggo
-
0
Despite the media reporting, the ‘dog suicide bridge’ is just an urban legend

At a time when we’re seeing the real-life perils of battling a virus pandemic, the tenacious tendencies of viral online stories become all the more apparent; They seem to spring from nowhere and ravage the population before a refutational ‘vaccine’ can be prepared. By then, the damage is done and many won’t swallow, or even see, rational analysis. This means it will rear its ugly head time and time again. Occasionally it’s repackaged with a new twist, but frequently just regurgitated with a retweet, a share, a copy & paste, or some other form of convenient thumbfoolery.

Phenome-none

The skeptic community is comparatively small, informal, and limited in reach. Fortunately, there’s an army of like-minded allies out there for us to collaborate with, to amplify, and to lean on at times when the fight against misinformation overpowers us; academics, investigative journalists, fact-checking organisations, science communicators, and researchers, to name a few.

As such, it’s doubly disappointing when one of those allies drops the ball. The most recent and high profile fumble comes from the hugely popular educational podcast Stuff You Should Know as they disappointingly regurgitated the story of Scotland’s Dog Suicide Bridge.

For a podcast which has built its success (millions of downloads every month) on diligent research and tentative declarations of truth with a deference to experts, they unfortunately failed to address the most fundamental question you should ask when investigating something: did it actually happen?

Tall tail signs

Overtoun Bridge approaching Overtoun House. Two dog walkers with small white dogs are walking towards the house. Photo by Dave Souza (CC BY-SA 4.0) https://commons.wikimedia.org/wiki/File:Overtoun_Bridge_-_approach_to_Overtoun_House.jpg

As with many of the best yarns to be spun, some reports of dogs jumping to their death from Overtoun Bridge near Dumbarton are true. Sadly, it has happened a non-zero number of times. Unfortunately though, the truth has been submerged by sensationalism, a sprinkling of paranormal activity, and even the distasteful leveraging of a genuine human tragedy that took place at the bridge in the mid 90s.

Rover-estimate

Regarding the number of canine casualties, the Stuff You Should Know hosts confidently declare “at least fifty that have been definitely documented”. Such documentation does not appear to exist, and they may well have happened upon that figure by simply reading old articles on the subject which make the same claim. Interestingly, doing just that gives us a fascinating insight into how viral stories can quickly spiral into the realms of the nonsensical, and periodically resurface to spread around a brand new audience.

Origin of the specious

The first mention we see of the story is a random comment on a blog post in 2005 in which someone mentions that they heard about the story of the bridge elsewhere. However, it was 2006 that saw the story truly surface into mainstream media, and it has been an ever-present since then.

Here are some selected examples. Many more are available with a quick Google:

Golden deceiver

The staggering ‘six hundred’ number is the one that seems to be sticking most recently. The origin of that number appears to be the 2009 article in Cracked. The author asserts without evidence that the jump rate has been one a month since the 60s, which totals up to “around 600 mutts”. This number has been picked up by many of the tabloids (the bigger the better, right?), and even the New York Times (another occasional ally who should know better) had a 2019 article which cited hundreds of deaths.

Vetting the data

It’s 5.45pm on a Friday and my phone rings. My working week is done, but for Debbie McDonald (BVMS MRCVS) of Glenbrae Veterinary Clinics there’s more to be done. Despite that she carved out a few spare minutes to talk to me about her perspective on the Overtoun Bridge story. Having worked at the closest practice to Overtoun Bridge for over two decades, she’s in a perfect position to speak with authority on the subject. In all that time there have only been two incidents from the bridge that came to her attention; one where the dog survived, and another where unfortunately it had to be euthanised due to the severe injuries.

Debbie is also a dog owner herself, and lives near the bridge. Having walked her own dogs over the bridge many times without incident, and having spoken to many other dog owners in the area who have done the same, she strongly doubts the huge numbers being quoted in the press. In her time working as a vet she’s dealt with many more dogs who have fallen from cliffs when out hillwalking with their owners. No suspicion of suicide, haunting, or anything else tabloid-worthy in those cases.

As for the handful of incidents that have actually happened at the bridge, Debbie’s explanation is simple and plausible: the bridge is an “optical illusion” of sorts, insofar as when you approach and cross it you may not even know you’re on a bridge until you look over the walls on either side. Many dogs may think they’re simply jumping over an obstacle to their explorations and expect to hit ground at the same level on the other side.

Thankfully even the tabloids have managed to report that suicide is, as far as we know, an exclusively human trait, and therefore not something we can attribute to the unfortunate dogs who perish in falls. They don’t appear to take the paranormal explanation seriously either, but tend to favour a suspicion that the dogs have caught scent of something and are bounding off to explore. Anyone who’s ever owned or met a dog will testify to how common that is.

The Overtoun window

The Scottish Society for the Prevention of Cruelty to Animals (SSPCA) also confirmed that they have no records, or reports to their helpline, of incidents involving dogs at the bridge. They did however offer the following statement from their chief superintendent Mike Flynn:

“Overtoun Bridge has a low point which, unfortunately, some dogs have managed to jump over in the past, resulting in their deaths.

“As far as we are aware, there is no evidence to support the theory that these dogs were committing suicide.

“Given previous incidents, we would advise pet owners in the area to keep their dogs on a lead to ensure their safety.”

Kennel of truth

In conclusion, there’s not really much to see here. Dogs are unpredictable, and better kept on a lead when there’s any doubt about their safety, or the safety of those around them. The rural myth of the Dog Suicide Bridge is as unlikely to die as most of the dogs that cross it, but we should hope that those allies of ours who genuinely value accuracy will delve a little deeper in the future.

I haven’t come here to bury the Stuff You Should Know podcast though, and much of what they do is praiseworthy. On a personal note, the dulcet tones of hosts Josh and Chuck have helped me through many bouts of insomnia over the years. They are unfalteringly kind, compassionate, honest, and have a good track record of acknowledging mistakes made. There are however times in the past when they’ve mentioned “the skeptics” in a less than flattering tone, which may speak to the fact that we skeptics are not always as polite and diplomatic as we could be.

Perhaps we can all do a little bit better.

How alternative medicine radicalises believers into Qanon conspiracy theories

Dave Hahn
-
0
How alternative medicine radicalises believers into Qanon conspiracy theories

We know a conspiracy theory when we hear one. The Moon landing never occurred, 9/11 was an inside job, we are living inside the Matrix, lizards control the British Crown/Vatican, COVID-19 isn’t real, and whatever it is that Q-anon is claiming (as it seems to change as each one of their deadlines expires). These are obvious cases that we either dismiss as “just conspiracy theories” or we, at the very least, steel ourselves for what the person is going to tell us is the real story.

What we do not think of as a conspiracy theory is the CAM claims of homeopathy, reiki, anything in the Goop catalogue, or whatever our spacey aunt tells us about her natural living regimen. However, I believe we absolutely should consider these types of claims as conspiracy theories for two reasons: firstly, they fit the definition of the term even thought this may not be obviously apparent. Secondly, these are the exact type of conspiracy theories that are roping unsuspecting people – who would normally claim to know better – into the Q-anon conspiracy theory.

A bottle of homeopathy, open with pills spread across a leaf and onto a table top. There is a wooden spoon and a book beside the bottle and pills.

The more controversial of these claims is that natural living, natural wellness, and CAM are conspiracy theories. Readers might be thinking that these people are merely wrong or misinformed, but they are not the same thing as a Flat Earther, or a George Soros caused COVID-19 type of claim. You may think they’re not even conspiracy theories: if you are selling a 12C dilution of Arsencium Album as a cure for cancer, there is no conspiracy theory there. It’s just a product being falsely claimed as an effective treatment for cancer.

That is correct, in that the person is not claiming a conspiracy theory, they are not even doing so in the way that conspiracy theorists like David Icke or Alex Jones claim conspiracy theories without calling them such. In my work I define “conspiracy theory” as a an “alternate explanation of an event/phenomenon, for which the central thesis is a coverup or concealment of the true explanation, by a group of actors, for which the evidence is inadequate to sustain the general claim;”1 then the homeopathic claims fit. So do the alternative medicine claims and a good portion of the natural living health claims as well too.

What’s difficult about this is that the people who advocate these positions may not even be aware of the conspiratorial nature of their claims. For example, if someone claimed that Bill Gates and the Illuminati are using 5G to give us COVID-19 as part of “Operation Lockstep” we know that is a conspiracy theory. There is a coverup, there is a group of actors, the evidence is inadequate to sustain the claim, and it runs counter to the official story. That’s our obvious case. If a person claims that 5G cellular radiation gives us cancer we can run the same test. The claim runs counter to the official story, the evidence is inadequate to sustain this claim, there are actors setting up 5G, and the only feature remaining is the coverup.

This is where the conspiracy theory begins, only instead of making an explicit claim of concealment this is all done by implication. For the 5G story to be true there has to be a massive global coverup of the effects of cellular radiation. It isn’t merely a passive ignorance of the media either, it would need to be an active suppression of any kind of evidence that would point to the problematic effects of 5G have on living tissue.

The same can be said with homeopathic treatments. It’s not just an alternative treatment. Assuming that they are telling the truth; what does that entail? It means that every single official medical establishment is involved in hiding the effectiveness of their dilutions. That every test that has ever been run to test the effectiveness of homeopathy has been corrupted by agents of this conspiracy. Every person who took only homeopathy to cure their illnesses was poisoned by agents of the conspiracy so that no other person would realize its healing powers. Finally, that mainstream medicine has coupled themselves into a complimentary relationship with homeopathy so that any beneficial results of the dilutions could be attributed to the mainstream science.

We are not only aware that homeopathy does not work, but that it cannot work. For it to be effective the laws of nature would have to be different, and thus, those very laws are part of this superconspiracy (Barkun 2003)2 to suppress the truth of this alternative medical treatment. This is not a direct conspiracy theory but rather a conspiracy theory via implication, or an implied conspiracy theory. The reasons that people come to these beliefs parallel with the reasons that people adhere to conspiracy theories. They do not trust the system, they believe themselves to be too smart to buy the official story, they have suffered some kind of personal tragedy that has caused them to reject the official stories. No matter how they got there; these kinds of beliefs all require that first, the person reject official medicine and science. Then they have to assent to the idea that those same officials are actively attempting to suppress the “truth.”

Perhaps you have encountered a natural living person at your spin or Yoga class; and being the good skeptic you start asking some probing questions in a legitimate attempt to understand why they think that certain rocks have healing properties or that “earthing” is an effective method of healing… whatever; but instead of a getting answers or attempts to change the subject you received an angry pushback followed by a series of seeming non-sequiturs about GMOs, Monsanto, and chemtrails. Finally, it is followed by an accusation of “sheeple-ness” and how the “elites” are out to get us. This response is the result of their assent to these kinds of implied conspiracy theories. Attachment to conspiracy theories is not based on a reasoned and logical assent to evidence (Levy 2019, Bortolotti and Ichino 2020). The attachment is emotional; and belief that some form of alternative medicine/natural living as the superior but suppressed form of medicine is an emotional belief.

An abstract watercolour image of pastel colours

If the conspiracy theorist can recruit a believer without that individual knowing that it is a conspiracy theory, it will be more effective. This is where Pastel-Q finds its opening. Pastel-Q is Q-anon without the upfront presentations claiming the Satanic pedophile cannibal rings and Tom Hanks drinking adrenochrome; it’s the David Icke pitch that lacks the 4th dimensional lizard aliens from Draco, and this omission makes it seem reasonable. It is sold in soft colors with uplifting images rather than the stark metallic darkness of Q-anon. For a person that believes disease is caused by 5G messing up their chakras rather than a virus; Q is off-putting whereas Pastel-Q which merely claims that “the doctors” are not telling us everything about COVID-19 is exactly what they already suspect. Their implied conspiracy belief already assents to everything but the final conclusion. These people can say, no no, it’s not that weird Q thing… but isn’t there something to the idea that we’re being lied to? Afterall who would be against saving the children?

Over a year ago, readers of the news were treated to long articles on whether our kids were spending too much time on screens and what kind of danger that was presenting to them. Now with COVID-19, they are spending all of their time on screens and those articles have all but disappeared. Why did this happen? What are they doing to the children through the screens? If we only get sick for a week why is your child not going to school anymore? These are the kinds of questions that pastel-Q asks in Facebook groups and reddit forums with members who would balk at claims of Satanic human sacrifice. People that looked with rightful distrust on those that stormed my country’s capitol building are agreeing with Q-anon that a force of unaccountable elites is threatening both their health and their children’s health. Since these people have already agreed to the implied conspiracy theory ingrained in their natural health/wellness groups it makes it that much easier. As long as the Q-evangelist doesn’t reveal too much too soon, the people will be roped in succumbing to the sunken cost motivation that will keep them in these beliefs.

[1] This definition comes from my PhD dissertation.

[2] This definition of a superconspiracy appears in Barkun’s book “A Culture of Conspiracy;” this word also appears in the Wikipedia page for “Conspiracy theory” which cites Barkun. It means a global Illuminati style conspiracy theory.

Should we be skeptical of homeopathy research conducted in India? A look at the evidence

Edzard Ernst
-
0
Should we be skeptical of homeopathy research conducted in India? A look at the evidence

“Homeopathy must be effective! It is used extensively throughout the world, not least India! If it were ineffective, Indians would not use it in such large numbers.” How often have we heard such arguments?

Take, for instance, statements from the ‘peer-reviewed’ literature such as this one: 

“At present, in India, homeopathy is the third most popular method of medical treatment after allopathy and Ayurveda. There are over 200,000 registered homeopathic doctors currently, with approximately 12,000 more being added every year.”

Or take statements from UK homeopaths like this one:

“It seems clear that homeopathy is there to stay in India. So next time you see or read some condescending and patronising rubbish about homeopathy in the media, know that in India, a country with a population of 1.2 billion people (that’s more than 20x the population of the UK) homeopathy is an integral part of the healthcare system and deeply respected by the people of that country.”

The appeal to popularity is, of course, an appealing fallacy – but, in the case of homeopathy’s popularity in India, it is not just that; there is another much more intriguing aspect to homeopathy in India: research into homeopathy published by authors and researchers in India. It has often been suggested to me that this research should not be trusted – as this is a grave allegation indeed, I felt obliged to look into the matter.

In January 2021, I searched Medline for ‘homeopathy, study, India’. This resulted in 101 hits. Of these 101 articles, 31 contained data published by Indian authors providing evidence related to the effectiveness of homeopathy. I decided to include these papers in an analysis. Below I quote first the title of each paper followed by the sentences from the 31 abstracts that best describe the direction of the results.

1. Multimorbidity After Surgical Menopause Treated with Individualized Classical Homeopathy: A Case Report
She was treated with individualized classical homeopathy and followed up for 31 months. She was relieved of the vasomotor symptoms and psychological disturbances of climacteric syndrome, her weight reduced, the ultrasound scan showed absence of lipomatosis/gall bladder disease/hepatic steatosis. Blood tests showed reduction of thyroid stimulating hormone and a balance in the lipid status. Individualized classical homeopathy may have a role in the climacteric syndrome and comorbidities after surgical menopause.

2. Therapeutic evaluation of homeopathic treatment for canine oral papillomatosis
The current study proves that the combination of homeopathy drugs aids in fastening the regression of canine oral papilloma and proved to be safe and cost-effective.

3. Deep vein thrombosis cured by homeopathy: A case report
The present case report intends to record yet another case of DVT in an old patient totally cured exclusively by the non-invasive method of treatment with micro doses of potentized homeopathic drugs selected on the basis of the totality of symptoms and individualization of the case.

4. Diabetic retinopathy screening uptake after health education with or without retinal imaging within the facility in two AYUSH hospitals in Hyderabad, India: A nonrandomized pilot study
AYUSH hospitals could provide a feasible and acceptable location for providing DR screening services.

5. Individualised Homeopathic Therapy in ANCA Negative Rapidly Progressive Necrotising Crescentic Glomerulonephritis with Severe Renal Insufficiency – A Case Report
A 60-year-old Indian woman was treated with classical homeopathy for ANCA-negative RPGN, and after one year of treatment, serum creatinine and other parameters indicating renal injury dropped steadily despite the withdrawal of immunosuppressive drugs; renal dialysis, which was conducted twice a week initially, was made rarer and stopped after one year. Classical homeopathy may be considered a potential therapeutic modality in severe pathologies.

6. Improvements in long standing cardiac pathologies by individualized homeopathic remedies: A case series
… individualized homeopathic therapy was instituted along with the conventional medicines and the results were encouraging. The changes in the laboratory diagnostic parameters (single-photon emission computed tomography, electrocardiograph, echocardiography and ejection fraction as the case may be) are demonstrated over time. The key result seen in all three cases was the preservation of general well-being while the haemodynamic states also improved.

7. Could Homeopathy Become An Alternative Therapy In Dengue Fever? An example Of 10 Case Studies
We present a retrospective case series of 10 Indian patients who were diagnosed with dengue fever and treated exclusively with homeopathic remedies at Bangalore, India. This case series demonstrates with evidence of laboratory reports that even when the platelets dropped considerably there was good result without resorting to any other means.

8. Homeopathic Treatment of Vitiligo: A Report of Fourteen Cases
In 14 patients with vitiligo treated with individualized homeopathy, the best results were achieved in the patients who were treated in the early stages of the disease. We believe that homeopathy may be effective in the early stages of vitiligo, but large controlled clinical studies are needed in this area.

9. An Exploratory Study of Autonomic Function Investigations in Hemophiliacs on Homoeopathy Medications Using Impedance Plethysmography
Homoeopathic medicines used as an adjunct was associated with decrease in parasympathetic modulations.

10. Embryonic Zebrafish Model – A Well-Established Method for Rapidly Assessing the Toxicity of Homeopathic Drugs: – Toxicity Evaluation of Homeopathic Drugs Using Zebrafish Embryo Model
Our findings clearly demonstrate that no toxic effects were observed for these three homeopathic drugs at the potencies and exposure times used in this study. The embryonic zebrafish model is recommended as a well-established method for rapidly assessing the toxicity of homeopathic drugs.

11. Treatment of hemorrhoids with individualized homeopathy: An open observational pilot study
Under classical homeopathic treatment, hemorrhoids patients improved considerably in symptoms severity and anoscopic scores. However, being observational trial, our study cannot provide efficacy data. Controlled studies are required.

12. Patients’ preference for integrating homeopathy (PPIH) within the standard therapy settings in West Bengal, India: The part 1 (PPIH-1) study
A favorable attitude toward integrating homeopathy into conventional healthcare settings was obtained among the patients attending the homeopathic hospitals in West Bengal, India.

13. Patients’ Preference for Integrating Homoeopathy Services within the Secondary Health Care Settings in India: The Part 3 (PPIH-3) Study
A total of 82.40% (95% confidence interval = 79.23, 85.19) of the participants were in favor of integrating homoeopathy services.

14. Obstetrics and gynecology outpatient scenario of an Indian homeopathic hospital: A prospective, research-targeted study
The most frequently treated conditions were leucorrhea (20.5%), irregular menses (13.3%), dysmenorrhea (10%), menorrhagia (7.5%), and hypomenorrhea (6.3%). Strongly positive outcomes (+3/+2) were mostly recorded in oligomenorrhea (41.7%), leucorrhea (34.1%), polycystic ovary (33.3%), dysmenorrhea (28%), and irregular menses (22.2%). Individualized prescriptions predominated (95.6%).

15. Relative Apoptosis-inducing Potential of Homeopa-thic Condurango 6C and 30C in H460 Lung Cancer Cells In vitro: -Apoptosis-induction by homeopathic Condurango in H460 cells
Condurango 30C had greater apoptotic effect than Condurango 6C as claimed in the homeopathic doctrine.

16. Beliefs, attitudes and self-use of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy medicines among senior pharmacy students: An exploratory insight from Andhra Pradesh, India
Pharmacy students held favorable attitude and beliefs about AYUSH use.

17. Integrative nanomedicine: treating cancer with nanoscale natural products
Taken together, the nanoparticulate research data and the Banerji Protocols for homeopathic remedies in cancer suggest a way forward for generating advances in cancer treatment with natural product-derived nanomedicines.

18. Evidence of an Epigenetic Modification in Cell-cycle Arrest Caused by the Use of Ultra-highly-diluted Gonolobus Condurango Extract
Condurango 30C appeared to trigger key epigenetic events of gene modulation in effectively combating cancer cells, which the placebo was unable to do.

19. Calcarea carbonica induces apoptosis in cancer cells in p53-dependent manner via an immuno-modulatory circuit
Our results indicated a “two-step” mechanism of the induction of apoptosis in tumor cells by calcarea carbonica

20. Post-cancer Treatment with Condurango 30C Shows Amelioration of Benzo[a]pyrene-induced Lung Cancer in Rats Through the Molecular Pathway of Caspa- se-3-mediated Apoptosis Induction: -Anti-lung cancer potential of Condurango 30C in rats
The overall result validated a positive effect of Condurango 30C in ameliorating lung cancer through caspase-3-mediated apoptosis induction and EGFR down-regulation.

21. The potentized homeopathic drug, Lycopodium clavatum (5C and 15C) has anti-cancer effect on hela cells in vitro
Thus, the highly-diluted, dynamized homeopathic remedies LC-5C and LC-15C demonstrated their capabilities to induce apoptosis in cancer cells, signifying their possible use as supportive medicines in cancer therapy.

22. Ameliorating effect of mother tincture of Syzygium jambolanum on carbohydrate and lipid metabolic disorders in streptozotocin-induced diabetic rat: Homeopathic remedy
The result of the present study indicated that the homeopathic drug S jambolanum (mother tincture) has a protective effect on diabetic induced carbohydrate and lipid metabolic disorders in STZ-induced diabetic animal.

23. SEM studies on blood cells of Plasmodium berghei infected Balb/c mice treated with artesunate and homeopathic medicine China
The combination of artesunate and China was found to be very effective and did not cause any alteration on the surface of blood cells as observed in SEM.

24. Induction of apoptosis of tumor cells by some potentiated homeopathic drugs: implications on mechanism of action
These data indicate that apoptosis is one of the mechanisms of tumor reduction of homeopathic drugs.

25. TDZ-induced high frequency shoot regeneration in Cassia sophera Linn. via cotyledonary node explants
Regenerated plantlets were successfully acclimatized and hardened off inside the culture room and then transferred to green house with 100 % survival rate.

26. Modulation of Signal Proteins: A Plausible Mechanism to Explain How a Potentized Drug Secale Cor 30C Diluted beyond Avogadro’s Limit Combats Skin Papilloma in Mice
We tested the hypothesis if suitable modulations of signal proteins could be one of the possible pathways of action of a highly diluted homeopathic drug, Secale cornutum 30C (diluted 10(60) times; Sec cor 30). It could successfully combat DMBA + croton oil-induced skin papilloma in mice as evidenced by histological, cytogenetical, immunofluorescence, ELISA and immunoblot findings.

27. Can homeopathy bring additional benefits to thalassemic patients on hydroxyurea therapy? Encouraging results of a preliminary study
The homeopathic remedies being inexpensive and without any known side-effects seem to have great potentials in bringing additional benefits to thalassemic patients; particularly in the developing world where blood transfusions suffer from inadequate screening and fall short of the stringent safety standards followed in the developed countries.

28. Effect of homeopathic medicines on transplanted tumors in mice
These findings support that homeopathic preparations of Ruta and Hydrastis have significant antitumour activity. The mechanism of action of these medicines is not known at present.

29. Inhibition of chemically induced carcinogenesis by drugs used in homeopathic medicine
These studies demonstrate that homeopathic drugs, at ultra low doses, may be able to decrease tumor induction by carcinogen administration.

30. Can homeopathic treatment slow prostate cancer growth?
The findings indicate that selected homeopathic remedies for the present study have no direct cellular anticancer effects but appear to significantly slow the progression of cancer and reduce cancer incidence and mortality in Copenhagen rats injected with MAT-LyLu prostate cancer cells.

31. Ameliorating effect of microdoses of a potentized homeopathic drug, Arsenicum Album, on arsenic-induced toxicity in mice
The results lend further support to our earlier views that microdoses of potentized Arsenicum Album are capable of combating arsenic intoxication in mice, and thus are strong candidates for possible use in human subjects in arsenic contaminated areas under medical supervision.

I know, this research is a bit ‘rough and ready’, but 31 of 31 yield positive results and conclusions; if my calculation is correct, that’s 100%. When I considered the possibility that Indian research into homeopathy might not be up to scratch, I was merely speculating on the basis of occasionally reading such papers. I had not seen a systematic analysis to justify my suspicion. In fact, I don’t think that such a review existed. I had no idea how true my seemingly disrespectful suspicion would turn out to be. There is not one paper from India that does not suggest positive findings for homeopathy. I find this truly remarkable.

We can, of course, interpret my findings in two very different ways, given that homeopathy research produced in India generates so many more positive results than elsewhere in the world:

  • Either we assume that homeopathy is hugely effective and works always and for everything under every experimental condition… in India.
  • Or we conclude that research from India into homeopathy is not trustworthy.

Which of the two is more likely?

New NICE guidelines on chronic pain fall woefully short – and not just because of the acupuncture

Alice Howarth
-
0
New NICE guidelines on chronic pain fall woefully short – and not just because of the acupuncture

Earlier this week, following a lengthy consultation, the National Institute for Health and Care Excellence (NICE) published new guidelines on chronic pain in over 16s. In the new guidelines, NICE – the body who set guidelines for what treatments the NHS should offer – made some recommendations for people whose chronic pain has no known cause. These recommendations include:

Acupuncture: “consider a single course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system”

Chronic pain is pain that causes distress or disability and lasts more than 3 months with no known underlying cause. NICE’s recommendations follow a classification from the most up to date version of the World Health Organization’s International Classification of Diseases (ICD-11) which defines it this way:

“Chronic primary pain is chronic pain in one or more anatomical regions that is characterised by significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles). Chronic primary pain is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate independently of identified biological or psychological contributors unless another diagnosis would better account for the presenting symptoms.”

The prevalence of chronic pain on the whole, and specifically of chronic primary pain, is hard to pin down for multiple reasons. Firstly, it is not always clear what terminology we are using when we refer to different conditions that are associated with pain – deciding which conditions constitute chronic primary pain and which are secondary chronic pain is not always clear cut. Additionally, medical bias, lack of resources and lack of awareness often lead to long delays in diagnosis. What we do know is that chronic pain affects women more than men and that medical bias relating to women, especially women from minority backgrounds, is prevalent.

The Good

So, what are the positive aspects of this recommendation?

There are a few as far as I can see. Firstly, NICE are attempting to offer guidance for person-centred assessment suggesting that doctors should “identify factors contributing to the pain and how the pain affects the persons life” with a focus on “enabling patients to actively participate in their care including communication, information and shared decision making”. This might seem like stating the obvious, but with a historic tendency of doctors to focus on a more top-down, prescriptivist approach, codifying this element of diagnostics is valuable especially when it comes to conditions associated with disability.

It also codifies responses to some common experiences of people who live with chronic pain, including explicitly stating “when communicating normal or negative test results, be sensitive to the risk of invalidating the person’s experience of chronic pain”.

NICE’s news article on the new recommendations say the “guideline emphasises the need for shared decision making, putting patients at the centre of their care, and fostering a collaborative, supportive relationship between patients and healthcare professionals. It highlights the importance of healthcare professionals gaining an understanding of how a person’s life affects their pain and how pain affects their life, including their work and leisure time, relationships with family and friends, and sleep.”

The approach of putting patients at the centre of their own care is a crucial part of supporting people with chronic health conditions who might previously have been subject to medical bias and lack of adequate support.

There are, however, some major downsides to the guidance and associated news coverage.

The Bad

Acupuncture needles are placed into the stomach of a patient

First is the recommendation of acupuncture – there is no good evidence that acupuncture is valuable for people with any health condition and including this in a recommendation completely undermines NICE’s claim that their recommendations are evidence based. In their evidence review NICE considered a number of studies relating to the use of acupuncture in chronic pain, but the vast majority of those studies were deemed low or very low quality by NICE themselves – in fact, not a single study was considered to be of good quality.

They go on to recommend that acupuncture should be “delivered by a band 7 (equivalent or lower) healthcare professional with appropriate training” or “delivered by another healthcare professional with appropriate training and/or in another setting for equivalent or lower cost” without consideration that this legitimises acupuncture from the wider alternative medicine community, and that it might put patients at risk of harm from unregulated practitioners, potentially exposing patients to the promotion of other alternative therapies that might put them in harm’s way.

The second issue is a little more nuanced. The new guidelines also offer recommendations for other forms of treatment:

  • Exercise: “encourage people with chronic primary pain to remain physically active for longer-term general health benefits”
  • Psychological therapy: “consider acceptance and commitment therapy (ACT) or cognitive behavioural therapy (CBT) for pain”
  • Pharmacological management: “consider an antidepressant [as] off-label use”. “Do not initiate[:] antiepileptic drugs, antipsychotic drugs, benzodiazepines, corticosteroid trigger point injections, ketamine, local anaesthetics, non-steroidal anti-inflammatory drugs, opioids, paracetamol”

On the evidence alone, I don’t entirely disagree with the recommendations of NICE to offer exercise, psychological therapy and to adjust the types of pharmacological agents that are given. Broadly, the evidence suggests that many painkillers either don’t have evidence of clinical efficacy for primary chronic pain or have evidence of low clinical efficacy for primary chronic pain. Similarly, exercise and psychological therapy have good evidence of value for people with primary chronic pain. But it’s not as simple as “exercise more and have therapy” because many people with chronic pain are not able to exercise, and access to therapy that is tailored to chronic pain is limited. Guidance on exercise needs to be tailored to the individual, considering their specific abilities, and this can require evidence-based medical supervision on how to exercise without causing increased pain or injury. You might even need painkillers in order to get through an exercise plan until you build up some strength.

This guidance comes within a wider a context and that context is one where those with chronic pain are routinely dismissed, given poor advice, overlooked and misdiagnosed. Even if a patient does get adequate support from a healthcare professional for their chronic pain, a lack of resources means many people do not have access to the sort of treatment that combines exercise and psychological therapy with education and support on how to manage chronic pain conditions. Waiting lists for CBT can be over a year long and many therapists do not have specialist understanding of how to apply their work to people with chronic pain.

A person holds a resistance band with their hand - a red spot indicates the pain they feel in their wrist

I know how hard it is to get good, evidence-based treatment for chronic pain. When I was in my mid-twenties, ten years after symptom presentation and over five years after diagnosis, I was given the opportunity to attend a Pain Management Programme that really looked to use the evidence to help treat people with chronic pain. This was a course that I attended for a full day, once a week for several weeks.

This programme was an educational programme for people with chronic pain that combined CBT, physiotherapy and education on how chronic pain really works. They didn’t tell me to stop taking my painkillers, but they did explain why painkillers often don’t help for chronic pain. They didn’t tell me to do more exercise, but they did give me a gentle exercise plan that would help me build up my strength in a gradual guided way, with tips for how best to manage flare ups and how to pace. They didn’t tell me the pain was all in my head, but they did explain how long-term pain modifies neural pathways in the brain and makes the pain worse even when there’s no physical explanation for it. They didn’t tell me to try alternative therapies, but they did explain that some people find those things helpful – they explained there was no evidence for it but if it helped for you it was ok to try.

In short, the course armed me with evidence, education, psychological support, physical support and a better understanding of the medication I was taking. They helped me build a suite of personalised tools based in evidence to help manage my own pain, and they put me back in control. But this sort of thing isn’t available for everyone. And in the meantime, if people have chronic pain that causes emotional distress and/or is disabling, we should be offering them anything that helps, even if it only helps a little bit or even if it only helps in a small number of patients. Sometimes that is going to mean painkillers. People who try painkillers for chronic pain are unlikely to keep taking the painkillers if they don’t help their pain. 

The final issue I have with this new guidance is with how it has been communicated. NICE released an article which said:

“The guideline makes recommendations for treatments that have been shown to be effective in managing chronic primary pain. These include exercise programmes and the psychological therapies CBT and acceptance and commitment therapy (ACT). Acupuncture is also recommended as an option.

“People with chronic primary pain should not be started on commonly used drugs including paracetamol, non-steroidal anti-inflammatory drugs, benzodiazepines or opioids. This is because there is little or no evidence that they make any difference to people’s quality of life, pain or psychological distress, but they can cause harm, including possible addiction.”

And this is what much of the news coverage reported on. An article in The Guardian reported:

“People suffering from chronic pain that has no known cause should not be prescribed painkillers, the medicines watchdog has announced, recommending such patients be offered exercise, talking therapies and acupuncture instead.”

When there is already such stigma around disability – particularly disability concerning chronic health conditions that cause symptoms including chronic pain – it is really dehumanising to pronounce that people with chronic pain shouldn’t take painkillers and should try exercise instead. It does the opposite of what NICE claim to want to do – it removes patient decision making and makes the conversation paternalistic and patronising.

‘Startling Stories’, illustrating ‘Strangers on the Heights’ by Manly Wade Wellman

Deborah Hyde
-
0
‘Startling Stories’, illustrating ‘Strangers on the Heights’ by Manly Wade Wellman
Cover of Startling Stories
Startling Stories – Strangers on the Heights by Manly Wade Wellman. A man holds a ray gun to the head of a scared skeletal being. The man uses his free hand to comfort the woman beside him, who is holding an illuminated cross. Date: 1944

This cover of pulp magazine ‘Startling Stories’ dates from 1944 and illustrates the book’s main feature ‘Strangers on the Heights’ written by prolific fantasy writer Manly Wade Wellman. It clearly features a reanimated cadaver – a zombie.

In retrospect, the twentieth century’s fascination with fictional zombies (which is ongoing – a note for those readers unfortunate enough to live in a cave) is traceable to Haiti’s occupation by the United States between 1915 and 1934. As is often the case with folklore, the astonished commentary of visiting outsiders was instrumental in drawing attention to religious traditions – traditions which had passed unremarked-upon for years in their own environment.

The idea ‘broke’ with the publication of journalist William Seabrook’s influential 1929 travelogue The Magic Island (1929). Seabrook clearly enjoyed his time in Haiti and wrote respectfully, if a little sensationally, of its inhabitants and their religion. But ‘gruesome’ sells better than ‘thoughtful’. It inspired a stage play and – far more famously – Victor Halperin’s film White Zombie (1932), starring horror-favourite Bela Lugosi. The movie’s theme is authentic to the folklore, in that the zombie is the victim rather than the perpetrator.

As American anthropologist and ethnobotanist Wade Davis put it: “In Haiti, the fear is not of being harmed by zombies; it is fear of becoming one”.

1...808182...151Page 81 of 151

Expert skeptical analysis of pseudoscience, conspiracy theory and claims of the paranormal.

[email protected]

About

Categories

Shop