Three weeks ago I attended a public lecture entitled Medicine and Homeopathy.
The latest from Melbourne University Health Initiative, the lineup included homeopath Isaac Golden and chiropractor Simon Floreani to present the argument for homeopathy. Public health physician and medical activist Dr. Ken Harvey and GP Dr. Stephen Basser, one of Australia’s most accomplished critics and analysts of alternatives to medicine, held the fort for medicine.
All but Stephen Basser feature in this video examining claims made by Isaac Golden about homeoprophylaxis. I was confident Golden would pull off a pleasant well meaning presence and equally confident Floreani would flounder and fall. As it turned out he never arrived, leaving Golden to retrace the tired old footsteps he’s been doing for years all by himself.
There’s a few things that I found novel. Golden was quick to label the Cuban homeopathic immunisation study (see video above) as “an intervention”, not a trial. This in one swipe silenced many a prepared question including my own over how the “immunised” demographic returned to levels of Leptospirosis infection similar to those found elsewhere in Cuba (non “immunised”). The “intervention”, which is quoted by homeopaths as hard evidence of efficacy is often criticised for poor methodology, lacking a control group and inexplicably failing to randomise subjects.
So by renaming it an “intervention” Golden could proclaim to have “evidence” and dismiss questions raised about its veracity being flawed due to poor trial practice. Throughout the “intervention” paper the rest of Cuba (RC) is presented where and how a control would normally be presented in a trial. Defenders of the caper point to RC as a quasi-control when it suits the need to convey comparative difference. Thus, Isaac has invented a nifty escape clause from defending poor methodology.
Another point (in fact an inexcusable failing) was Golden’s inability to address what is at once one of the least complex problems, but perhaps the most important. The entire Cuban scam is not Hahnemannian homeopathy. By no means am I the first to note this. It’s more of what I call Supercalifragilistichomeoprophylaxis.
During the evening Isaac Golden made much of remaining true to Samuel Hahnemann’s Law of Similars and Law of Infinitesimals. The Law of Similars is sometimes known as “like cures like” and states that a mother tincture should be made from a substance which produces symptoms similar to that produced by the disease.
Yet in the Cuban study they used four dead – completely inactive – strains of Leptospira bacteria to make the mother tincture. The paper refers to “highly-diluted strains of inactivated leptospiras”. However the paper title is, Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control. Plainly that is misleading in itself.
So I pointed out to Isaac that in view of his insistence upon the law of similars, and noting that the Cuban mother tincture didn’t contain a substance that could produce any symptom like those experienced with leptospirosis (the bacteria were always dead), he had a problem. Confident, he responded that no, it’s not like a traditional vaccine.
Another audience member ran it by him again. Isaac was confused. Ken Harvey explained the problem also. Then I spelled out the obvious. Without the Law of Similars, there’s no Law of Infinitesimals. But he didn’t hear. Clearly stumped, his mind was cranking over. Eventually he produced the claim that the dead bacteria still had the “energy shape” or “energy signature” and were thus still viable. Quickly he turned and selected another questioner.
I was delighted. Isaac Golden had just told me an “energy shape” could produce similar symptoms to live bacteria. But even better, he’d made it up on the spot. After earlier signing his name to the Law of Similars, he then denied its necessity. I still wanted to press the point as this excuse couldn’t explain the “blood, puss, discharge, urine, flesh, causal organisms…”, and other organic goo used in highly dilute nosodes.
No Law of Infinitesimals either with no Similars. We never really made it to discuss that point. But I already had my answer in that he had no answer. For the record, the beaker for the most dilute agent was washed out 9,999 times. On the 10,000th refill it was called a homeopathic immunising agent. That’s not highly diluted – that’s washed away. The less potent (less dilute) was washed out 199 times.
It was Supercalifragilistichomeoprophylaxis if ever I’d seen it. Remember dear reader a nosode is a homeopathic dose. Golden had earlier used the term. Its definition – in this case – demands “causal organisms”. Energy shape just didn’t make it. The audience member who helped Isaac understand wrote, “Get out of jail free” on his notepad and slid it my way. I had to agree. We know homeopaths make it up as they go along, but it was really nice to be there to see that actually happen.
It was truly a Golden moment.
Other points deserve a mention. Already referring patients to conventional doctors, Isaac came across as keen to extend conventional connections and is striving to make something of a research base. He does not entertain the “us and them” combative mindset of the Monika Milka’s and anti-vaxxer types we know and love, and appeared genuinely keen to reciprocate with bilateral trials. One concern was his allusion to conspiracies, when it was pointed out that if efficacy was truly and constantly demonstrable that widespread use and marketing would already be apparent.
One couldn’t miss however that the totality of discourse and questioning was biased toward examining the claims made by Isaac. He did after all kick off by stressing he heals the “entire person”. This means mental, physical, personal, spiritual and probably “quantumal” for all I know. This was “natural medicine” to Isaac. Getting the human healing abilities to function on these levels.
We were promised lots of evidence but regrettably a few excuses related to third parties were raised. Aside from the Cuban standard, Isaac brought in the Swiss “study”. Written by pro-complementary medicine interests for governmental review and favouring popular demand it was a poor choice as the material is known to be highly selective in favour of homeopathy. Isaac appealed to popularity and use as equating to efficacy a number of times.
Dr. Stephen Basser’s deconstruction of why homeopathy is so widely used, sought after and applied by medical professionals was excellent. It highlighted the factors outside of efficacy that drive uptake and continued use of demonstrably non efficacious options. Patient request or demand, choice of placebo, doctors’ role in monitoring complex patients, marketing, what it’s actually used for and the context of these figures.
I’ve noted here before how chiropractors boast how many Aussies per day use chiropractic – after signing them into treatment contracts. Purchasing 100 doses of a homeopathic preparation doesn’t support it being entirely used. Nor do uptake figures represent clearly articulated failures – and dissatisfaction. What is regular? What is novel or first time? And so on. In short there is no association between popularity and efficacy. Or between demand and documented efficacy.
Ken harvey brought up the point I’d have guessed most would have asked at question time. Golden claims to have completed his PhD successfully in homeopathic immunisation. In Golden’s abstract we read:
The effectiveness of the program could not be established with statistical certainty given the limited sample size and the low probability of acquiring an infectious disease.
This didn’t stop Golden from then claiming:
However, a possible level of effectiveness of 90.3% was identified subject to specified limitations. Further research to confirm the effectiveness of the program is justified.
Despite defending the semantics on the night, it’s clear this air guitar of a PhD has only mused over a possibility.
One thing agreed on at the beginning was to not discuss the mechanisms of homeopathy. In other words, to avoid raising the fact it is physically impossible. This did allow the discussion to move forward. In essence, Golden was awarded a huge concession with respect to reality. Something of a microcosm of the larger homeopathic industry perhaps.
All up it was an interesting night given that no new evidence popped up to support homeopathy. Like many homeopaths Isaac really believes in it.
He just needs to conclude that ones belief is not truth.
When I was a kid, my mum had a sure way of finding out what we meant when describing something as “funny”.
“Funny Ha Ha or funny strange?”, she’d ask, and when suitably availed of an answer could turn her attention to following whatever enormously important point kids tend to make. Looking around today however, “funny strange” is thoroughly outdone by the eerie normality with which faith and belief in demonstrable and dangerous fallacies pass us by.
Using “funny” as our proxy description of weirdness, one may consider the present day feverishness with which cognitive bias is clung to, literally hilarious. In what passes for our first generation and more to have lived in the Space Age, there is an abundance of not just unscientific, but viciously anti-scientific beliefs to choose from. So ubiquitous, so easily tolerated, so poorly regulated is this tsunami of irrationality that one cannot miss that we live now in a new age of hilarious ritual and superstition.
In this Age of Hilarious there are some undeniable and durable trends. From hip healers, to AIDS denial, to scheming chiropractors, to cancer cures, to creationist museums to vaccine denial merchants and even the screaming lunacy of the freedom and conspiracy lovers, one enemy glues them together. Science. Without rattling off the volumes of anti-science movements – many of whom claim to be immersed in science – the same thought justification applies. Science is bad, evil, unnatural, open to unwholesome thinking, an unwelcome intruder upon the family, upon motherhood and upon health.
Its agents are intent on hiding the truth and in exploiting our species. It has destroyed the planet and wants to destroy us. It has permeated so much of our lives that to those worshipping in the Age of Hilarious it’s axiomatic as to how malignant Science is. To use Science – or something tainted with its touch – in thinking or in decision making draws mockery and derision is many circles. It is at once corrupt and the vehicle for the corrupt to continue their corruption. Nonsense has become normal to the point where presenting facts earns inane insults. From Pharma shill in citing undeniable facts on vaccination to Zionist or Jew Boy for querying the logic of 9/11 as an inside job.
Yet despite the pointy ends of these beliefs, the hub from which it all comes probably tells us much about human nature. Those who embark on evidence denial often challenge critics or defend their illogical meandering with the unwarranted observation that Science doesn’t know everything… it can be wrong… the universe is infinite… there’s more to discover… I say “unwarranted” criticism, because no-one knows this better than those who understand science. Nothing else adheres to these observations as strict rules but the Scientific method itself.
I tend to hear this challenge more as a plea. Those who deny evidence with little thought hold to an ideology wherein they want to live in a mysterious universe. Alienated by the ordinary and mundane everyday explanations and foregone conclusions in the Age of Hilarious, they have essentially no notion that so much of what we take for granted now, was once never so. Perhaps a total mystery, a brutal fact of nature, an expensive time wasting ritual of ignorance or a serendipitous discovery.
Today there are so many millions living with so much explanation that the human needs for mystery, discovery or the urge to conquer intellectual fulfillment must certainly go unrealised. Is it so unusual then that an instinctive response may be to create the “unknown” or perhaps do this by denying what is known? To use the term conveniently, if we accept that humans have spiritual needs, nothing defines the denial of evidence and advancement of belief via ignorance better than the Creationist/Intelligent Design movement.
Finally the dots linking Science to Satan were joined. The Discovery Institute’s “anti-evolution” Wedge Strategy for “renewal of science and culture” begins with the breath taking lie:
The proposition that human beings are created in the image of God is one of the bedrock principles on which Western civilization was built. Its influence can be detected in most, if not all, of the West’s greatest achievements, including representative democracy, human rights, free enterprise, and progress in the arts and sciences.
Apart from its beaming intellectual revulsion, what strikes me most about the Wedge Strategy is its timing. Ideas from The Enlightenment (1650-1790) helped shape the most famous democratic documents in history. The intellectual forces it released have sustained reason and humanity above many attempts to counter Enlightenment philosophies. Although intellectual resistance began as early as 1800 the Industrial Revolution had already seen science secure its place as indispensable. After the two World Wars of the 20th century, then the Cold War, and the control of polio, science and democratic rights eventually opened the way for the quality of life that provided the luxury to be… well, stupid.
The timing was perfect to have Creationism – later renamed Intelligent Design – introduced as a new scientific area. Or rather, as ancient myths brought to life under the authoritative and credulous banner of Science. Thanks to godless communism and Billy Graham, Pentecostal, Baptist and Evangelical movements were well established. Biblical literalism was (and is) quite absurd but it did not want for believers. At the same time, the space race and the Apollo 11 moon landing succeeded in opening our eyes to new scientific wonders and understanding.
Punctuating this clash, and now forever in history, is the Apollo 8 Christmas Eve broadcast of 1968. The first astronauts to orbit the moon took turns to read from the book of Genesis, sending lunar images back to Earth.
By the time the sexual revolution and self discovery of the 1960’s and 70’s had passed, traditional religion offered cold, boring irrelevance. Confidence in mystery, cosmic wonder and supernatural interference had been blasted with knowledge, understanding and explanation. Faith was no longer a noble virtue. It was the absence of evidence and reason. Rather than a scattering of giant intellects condemning the folly of belief, it was an established widespread fact. Even worse the damage and perversion linked to religions was becomming manifest.
Science continued to do amazing things, spitting out new disciplines and knowledge as computer power took its place. Medical science wiped out smallpox in developing nations and extended the human lifespan in developed nations. Alien abductees and spoon benders were being challenged by these chaps known as Skeptics, but it was soon clear a new irrationality had taken root. Suddenly Noah’s Ark was discovered. Then again and again. The Age of Hilarious was upon us.
The ever increasing “natural” alternatives to medicine demanded more respect. Unable to provide evidence to back claims, denial of evidence and attacks on science began. Faith and high risk belief once again offered noble qualities. The alienated could belong. The challenge of ones character that led to such horrors during the middle ages: “How strong is your faith?”, underscored the rising anti-vaccination movement and its many “healing” cousins that in truth, do nothing but delay healing.
On another level the lessons learned from Intelligent Design proponents were being employed deftly by both climate change denialists and those with a vested interest in discrediting climate science. Except in this broadband age the change around from acceptance to denial occurred at breath taking speed. They too have their own “science” – a Global Warming Curriculumdesigned to undermine genuine science. Rather than the Discovery Institute befouling evolution and biology it’s the Heartland Institute generously funding a violent attack on climate science.
These factors aside the sheer numbers of people that now reject climate change, their high priests and the well established conspiracy language used is compelling stuff. Certainly it resonates well with anti-Enlightenment identities like Miranda Devine, products of The Age of Hilarious, who proceed to damage the field of discourse irreparably. So rigid are her anti-climate devotees a great number sprang to her defence when she blamed the London riots on equal rights and same sex union. The woman writes predetermined right wing vengeance, yet “great piece”, “wonderful article”, “blah blah”, flow across Twitter regardless of topic, as she insults critics with her baton of misplaced importance.
There are the Creationists who speak of climate science in the same tone I speak of war crimes. To confuse the mix other enemies of reason accept climate science not because they have the skill to choose a valid source, but because they are beholden to their misconception of “natural”. Yet far from potential allies in managing the fallout from climate change they contribute to delayed action on their own field of play. Destruction of GM crops. Misguided animal rights. Spreading misinformation about vaccination as a means to population control. It’s not smaller healthier and wealthier families they see emerging to bring developing nations out of poverty. It’s “human culling” via vaccine.
A common factor in all beliefs held by enemies of reason in the Age of Hilarious is the misconception of “research” and “conclusion”. We hear this with so many pseudo-scientific endeavours and particularly with climate denial and vaccine denial. People claim to have spent time researching vaccines, for example, only to follow on with the “conclusion” it’s best not to vaccinate their children. Yet whatever they have read has all the accuracy of that which leads others to deny evolution announcing, “If we evolved from monkeys why are there still monkeys around today?”. Or to quote Kent Hovind, he hasn’t seen “a squirrel give birth to a pine cone… a dog give birth to a non dog”.
Vaccine denial relies on the towering ignorance of the over-confident or the thunderous immorality of the callous and cunning. One can accept that it is surely impossible to properly study immunology and that they must trust the scientific consensus. Or alternatively one can crave the nobility of faith, the piety of belief and insist on not being “a sheep”. In truth no amount of reading without evaluation and practice justifies the often heard claims of superior intelligence.
The Dunning-Kruger effect occurs when incompetent people not only fail to realise their incompetence, but consider themselves much more competent than everyone else. Basically – they’re too stupid to know that they’re stupid
Complicating this further is the in-group thinking that accompanies the anti-science crowds. Consider the Chiropractic Association of Australia. The Australian Homeopathic Association. The Australian Vaccination Network and other organised conspiracy movements. All these groups and many more exhibit a lack of any skill to discern the value of information. Ideology and belief is what drives them. Today, claimed intelligence and the accumulation of knowledge do not make for good decision making.
The sheer volume of information means we are better served by developing the skill to choose what sources to trust. Though I imagine for some they are at an extreme disadvantage. The constant urge for intellectual risk in the supposed realm of the unknown, once served by genuine mysteries, is a cognitive detriment. Hearing someone like Meryl Dorey talk, sets off warning bells like reading a scam Nigerian email offering me untold wealth in the worst grammar possible. Yet for others she is the cult figure that completes the circle of irrational belief.
It seems we develop intellectual tools in the absence of any skill to use them. No doubt that goes for all of us and highlights the importance of critical thinking. Vaccine denial appears in many cases to be justified by stories of cognitive dissonance that are resolved to an eventual cognitive bias which is then fed to the point of a splendid Dunning-Kruger effect. Intellectually the inability to use certain tools most often results in failed comprehension. But combined with the inability to gauge risk the anti-vaccine movement is overseeing a resurgence of disease. Consider this comment approved by Meryl Dorey on The Australian Vaccination Network Facebook page.
Inability to understand risk-benefit is a feature of The Age of Hilarious
The developing world is for those of us in the Age of Hilarious much like where a time machine would take us if we went backward and forward to gather information of vaccine preventable disease (VPD). Today, one child dies every 20 seconds from a VPD. Pneumonia and diarrhea are the biggest killers in developing nations whilst these are prevented by Pneumococcal and Rotavirus vaccines. As the AVN’s Judy Wilyman rails against the HPV vaccine, dismissively citing developed nation levels of cervical cancer the reality is 270,000 women die of HPV related causes annually – 85% in developing nations.
The smallpox vaccine saves $1.3 billion annually – 10 times the cost of the original program. Typhoid kills 200-600,000 per year and in developing nations congenital rubella syndrome still claims 90,000 lives annually. The cost to a family of a disabled child or adult often combined with the loss of a mother is to us, incomprehensible. Vaccination allows for improved health and growth. Children go on to attend and finish school. They contribute to family life and when eventually employed raise the family income to levels usually not dreamed of.
The more children vaccinated the more that live and the more that live the less that must be “produced” by parents to compete with the present law of attrition. In countries with high VPD one doesn’t expect to see children grow. Rather one hopes against the odds enough will grow to sustain a bearable quality of life for the family. With vaccination quality of life improves dramatically. Families, villages, districts and even nations can be pulled from poverty.
The GAVI Alliance – previously Global Alliance for Vaccines and Immunisation – fund 97% of pneumococcal vaccination in developing nations. In the last decade they have pushed hepatitis B vaccination in China above that in Australia and placed a virtual halt on liver cancer.
Yet comfortable in their scientifically endowed lives, fully vaccinated as children and content with two kids, vaccine denialists in developed nations insist the reduction in family numbers and misery is planned genocide. They ridicule charities and sabotage attempts to raise money for, or educate about, the success of vaccination in less fortunate nations, as yet free from the Age of Hilarious. Which raises the question: what are they free from?
A typical example is that recently Mia Freedman wrote an article about the self appointed experts of the anti-vaccine movement. Mia shreds the AVN ticking all the boxes about their false “choice”, the farcical name, the pretend expertise… in fact the truth. One quote I like which applies because the benefits of vaccines are irrefutable is, “In fact there aren’t two sides and there is no debate. On one hand there is science and there is no other hand.”
Dorey went berserk, summoned her flying monkeys and actually had them writing to Mia “from the other side”. The attacks were typical. “What a bl**dy parasitic moron journalist!” commented one. Her article was likened to eugenics, she was a moron, and idiot. She was an ignorant douchebag, rude, self-righteous, uneducated and hateful…. One can only imagine the emails out of the public eye.
Mia tweeted:
To which Dorey shot back “What threats? How about listening to parents of vaccine damaged kids to learn about the other side if (sic) vaccination? YES-2 sides!”. Which is terribly ironic as many have asked to see these crowds of vaccine damaged children that Dorey so liberally exploits. At the same time anyone presenting evidence was banned and their posts deleted – as usual. One member managed to remain leaving:
Mia writes engaging articles with compassion, empathy and humour. Many, many commenters on MM disagree with her position on many issues but as long as they’re not abusive, the comments stay. That’s why she has such a vast audience. You should try it, Meryl. You might find your audience grows instead of shrinking away and hiding on closed websites and Facebook pages.
And (to the author of the above Facebook comment – but not in response to that comment):
… why are you being so mean? You do realise that lots of people – genuinely curious people – will come to this page after reading Mia’s column? If I were you I’d be using the traffic to make a reasoned argument in a friendly forum. Mocking and insulting a well loved and popular writer (even if you disagree with her) is not doing your cause any good.
All in all it continued on for some time. I was riveted at how far the antivaccination movement – or is it just Dorey’s mob – had fallen. I could not find any arguments or attempts at discourse beyond vicious, wailing ad hominem abuse. Dorey wrote her usual scathing personal reply seeming to latch onto two sentences that distort Mia’s intent:
I’m certainly not suggesting we become a flock of sheep or suspend critical thought. But I don’t need to ‘do my research’ before I vaccinate.
Dorey used this to accuse her of being a sheep proffering, “Well duh! If you don’t do your research first Mia, may I suggest you open wide and say baaaaaaaaaa!”
But the full paragraph is clearer:
I’m certainly not suggesting we become a flock of sheep or suspend critical thought. But I don’t need to ‘do my research’ before I vaccinate. Or before I accept that the earth is round and that gravity exists. Scientists far smarter than me have already done that research and the verdict is unanimous, thanks.
Therein lies the impact of Mia’s article. Cries of “I’ve done my research” just don’t cut it with something as irrefutable as vaccination. From a safety viewpoint, it is open to abuse and argument less than regulation of the aviation industry. I would also argue, one needs the skill to discern a reputable source rather than embarking on piecemeal “research”. And in this Age of Hilarious it’s plain that Meryl Dorey is a source of dangerous nonsense.
To top it off Dorey made her seventh appearance on Friday at Conspiracy Central Airwaves aka Fairdinkum Radio. I’ve snipped 3 minutes of grabs below [or MP3 here]. It opens with Leon Pittard criticising science and the “technocracy” we’re moving into. It continues with Big Pharma terror then Dorey attacking Mia Freedman who “is a product of the governments health policy [which is] everyone must vaccinate and we need to fear and hate those who don’t do it”. That’s right dear reader – that’s government policy according to Dorey. Just like racism she contends.
Despite knowing the pertussis vaccine gives dubious immunity and no vaccine is infallible Dorey can’t seem to grasp Mia’s argument that an unvaccinated child is a risk to all Australians, vaccinated or not. Meryl should read this post from a mother whose vaccinated daughter caught pertussis from an unvaccinated child and three months later, “is prone to chest infections, pneumonia, and more susceptible to viruses and Influenza.”
In the same program Dorey again repeats the myth that no children died of pertussis in the ten years to 2009. Reasonable Hank deals with it splendidly. Why she keeps insulting her hosts and listeners like this I don’t really know, only to politely assume it’s linked to the pitfalls of cognitive bias above. Between 1993 – 2008, 16 children under 12 months died from pertussis. Dorey is well aware of this. And so her cult-like cycle of bald faced untruths continues.
French atheist, philosopher and author, Michel Onfray suggests the coming century will be the century of religion. He is probably right, but exactly what form the religions will take and what passes for belief and faith might be hard to recognise by its end. Consider Scientology for a salient example.
Whatever the case it seems that for a number of reasons from human psychology, to arrogance to simple power and profit the Age of Hilarious will persist for a while yet.
Dr Forte’s title of Doctor does not imply that he has any academic medical qualification. He does not. It is a courtesy title only and, ethically, is only utilised in the context of his chiropractic practice.
From Inquest finding into death of James Halloran, S.A. April 1st 2010
Mario Forte progressively lost his sight over many years.
Although holding a diploma in sports massage and working part time for himself, his loss of vision demanded a professional downgrade. By the mid 1980’s he would see only shades of light and dark. By the late 1990’s he would be totally blind. As a masseuse he would be subject to reviews, retraining, infrequent accreditation and occasional inspection. There would be… standards. Problems were foreseen (no pun intended).
Could there possibly be a related discipline that allowed contact with patients whilst you pretend to be doing something but actually do nothing? Where you just make stuff up and claim it is of the highest standard? Of course – Chiropractic! In 1978 he began training with a qualified chiropractor for a period of three years.
In the same year he began his own practice at home, whilst still working part time with his trainer. In 1979 he was accepted as a member of the United Chiropractors’ Association of Australasia Limited. When the Chiropractors Act 1981 popped up he became registered under it and has remained so ever since.
In December 2006 Mr. James Halloran visited Forte at his practice at the rear of Forte’s elderly father’s address. At some point Mr. Halloran collapsed and became “convulsive, unconscious [and] unresponsive” on the floor. Australian Doctor report that Forte rang a colleague (4 minutes) discussing options. He then rang a local doctor’s practice, whereupon he was advised to call 000. He ignored this advice.
Three minutes later he tried to call another general practice without success. Then he called 000. Time wasted: 9 Minutes. He fetched his elderly father and Forte claims they did their best to administer “late and inadequately executed” CPR.
Forte had guessed Mr. Halloran was suffering an epileptic fit. As he is totally blind and chose to work alone, a couple of problems with this spring to mind. Although he had no idea of Mr. Halloran’s medical history, for my money, if you’ve got to pick something along the spectrum from “practical joke” to “massive stroke or other cardiovascular event”, then epileptic fit is as good as any.
However, the S.A. Health Practitioners Tribunal, past whom no detail no matter how small shall pass without scrutiny noted that Forte was:
… effectively unable to monitor the patient’s vital signs because he was blind
Yay verily. They continue their astonishing insight:
In other words he did nothing effective towards assisting his patient during this time… He could not check pupil dilation and the other things that would depend upon vision, such as skin pallor or foaming at the mouth. The fact that he could not do so and had that limitation should have occurred to him.
Combining up to the minute health practice knowledge and 2 years hindsight of a 37 page Coronial Inquest Report they offer with blistering understatement:
[Even] if Mr Halloran was to die, Dr Forte’s negligence and incompetence remains just as grave, not in respect of the outcome but in respect of the fact that he did nothing.
This last statement is made due to the fact that Forte was cleared of contributing to Mr. Halloran’s death despite the Deputy State Coroner noting:
Dr Forte at times in his evidence had a reluctance to give a responsive answer to the question asked of him and was unduly intractable and argumentative. […]
In the event, I have not needed to resort to the evidence of the admission to make any finding about whether Dr Forte applied force to the cervical spine, but I do say that [“an impressive professional individual and indeed an impressive witness” – an attending paramedic’s] evidence raises a nagging doubt in my mind as to whether Dr Forte was being completely frank with the Court.
In short Forte had admitted manipulating the spine to paramedics yet testified that no such conversation took place and denied manipulation. As it eventuated the cause of death could not be isolated to having originated from his manipulation. There was pathology evidence pointing to a vertebral artery embolus that had originated elsewhere. This could have caused a respiratory arrest followed by a cardiac arrest. But this cannot be determined. The rare event of vagal inhibition leading to cardiac arrest was raised and dismissed.
In any event death resulted from lack of oxygen to the brain as a probable and direct consequence of Forte’s apathy. From the Inquest finding:
One thing that Dr Gilbert was certain about was that the global brain injury suffered by Mr Halloran was entirely consistent with his cardiac arrest and the consequent lack of oxygen delivery to the brain during that hypoxic period. Dr Gilbert suggested that a brain could survive without oxygen and not be damaged for a period of the order of 2 to 3 minutes. […]
If he was obtaining effective CPR, the 9 minutes that had been suggested might not be regarded as a full 9 minutes of hypoxia. The damage to the brain might not be as extensive as it would be if there had been a period of 9 minutes without CPR. Nine minutes of deprivation of oxygen would, however, involve a lethal insult to the brain and would cause a global severe anoxic injury incompatible with life. […]
All that said, it will be remembered that whatever the position was, Mr Halloran did suffer a severe global anoxic brain injury which signifies very strongly that there was a significant period of time following his cardiac arrest during which he was receiving no oxygen regardless of the competence of any CPR.
It must be noted that the emergency dispatch operator had offered to give CPR instructions to Forte’s parents who were present. Forte agrees with this. CPR was not commenced until 19 minutes after Forte called the other chiropractor to discuss options. At a minimum Forte spent 13 minutes alone with the deceased before physically going to fetch his parents.
However long beforehand Forte had taken guessing an epileptic fit is simply not known. His information is, for whatever reason, flawed. There were two emergency calls, the second including the offer of CPR instructions, yet he at first insisted there had been only one. The paramendic observed “very, very blue” extremities suggesting no effective CPR had taken place. Forte holds a lapsed St. John’s First Aid certificate.
This tragic event highlights much of what is wrong with the pseudoscience of chiropractic masquerading as a health provision service. There is no question of Forte’s ability to manage and triumph over his blindness. Yet one must seriously query exactly what support or interventions were instigated on behalf of the Chiropractic Association and the more responsible Chiropractic Board of Australia to address Mario Forte’s obvious needs and the consequential risk to each and every of his patients. This in turn raises serious questions about accreditation and basic standards.
Let me spell it out. How the hell can a practising chiropractor not hold a current First Aid certificate? There is simply no excuse.
Ill people are fooled by the abuse of the title “Dr.” and the absurdly ambitious claims made by this careless, arrogant and woefully trained sham discipline. Had proper CPR been administered and anoxic brain injury averted Mr. Halloran may likely be alive today. A method for coping adequately with such events should have been available and well drilled. Despite Forte’s shortfalls as an honest witness he has certainly been failed by his profession.
As for the cause of Mr. Halloran’s cardiac arrest we can only glean a possible hint from 3.6 of the Inquest report:
Mr Halloran had not consulted Dr Forte prior to the occasion in question. It is not known whether, at any time prior to Mr Halloran’s arrival at Dr Forte’s clinic, Mr Halloran had any appreciation of the fact that Dr Forte was blind, but it would have been obvious once he arrived.
Across the globe it is known how important the pertussis (whooping cough) vaccine is in preventing both infection and severity of infection with Bordetella pertussis.
Along with vaccines for diphtheria and tetanus, then polio (1950’s), measles, mumps, rubella (1960’s) the Australian pertussis vaccine has contributed to an astonishing 99% reduction in deaths from vaccine preventable disease. Just after the turn of the century pertussis, diphtheria and tetanus vaccines alone had saved over 70,000 lives whilst the population had almost tripled since their inception. Since then pertussis vaccination alone has saved around another 10,000 Australian lives.
From the World Health Organisation, to national or state health authorities across developed nations to your local doctor, the evidence is compelling. Although anyone can catch pertussis it is babies under 12 months who are most vulnerable to infection. The disease can cause disability and death in the unvaccinated. Whilst immunisation provides antibodies to fight pertussis, it does not provide “magical protection”. For that you need chiropractors or other practitioners of alternatives to medicine.
Immunisation against pertussis does mean:
A significantly reduced chance of being infected
A significantly reduced severity of infection if infected
Protection of unvaccinated individuals that one may come into contact with
Low levels of community infection with high levels of immunisation
Pertussis epidemics follow on from reduction in immunisation across the community, leading to a drop in herd immunity. The present epidemic Australia is experiencing began in Byron Bay, an area with very low immunisation rates, and then spread to other areas of low immunisation. From the backyard of Meryl Dorey’s anti-vaccination lobby group the seeds for this epidemic were sown a decade ago. Brynley Hull and Peter McIntyre wrote in January 2003 [page 12]:
Although immunisation coverage has greatly improved over the past five years in NSW, and many areas have reached coverage targets, there are areas in NSW where the level of registered conscientious objection to immunisation is great enough to affect immunisation coverage, as measured by the ACIR. One such area is northern NSW, and the Byron Bay SLA in particular, where the rate of conscientious objection is one of the highest in the country.
Despite the crystal clear science and undoubted success of immunisation, movements against all vaccines have grown. They have kept pace with internet driven conspiracy theories, imaginary diseases, imaginary cures and new age beliefs. The most successful currency used by those opposed to scientific success is ignorance and misinformation.
An excellent example regarding pertussis vaccination is that many people incorrectly believe all vaccines, with the exception of influenza, provide lifelong immunity. With pertussis, vaccine induced immunity wanes over time and as noted above whilst it reduces the chance of infection, it is not an impervious shield. Antivaccination lobbyists have taken advantage of this to infer that the pertussis vaccination schedule itself has failed. First, we have ignorance – the expectation that immunity is lifelong. Then follows misinformation.
For example as debunked here more than a few times, figures describing vaccination levels and notification of infection are frequently misused by the Australian Vaccination Network to falsely refute the efficacy of immunisation. Yet these clumsy attempts are piecemeal and misleading. Time and again infection notification and vaccination status is highlighted and infused with qualities that serve to misinform. Placing figures in context yields a very different picture which, given that they seek to deny international trends that have existed for decades, is not surprising.
The question, or challenge if you will, is about the veracity of the pertussis vaccination schedule. Thus we must take care to ensure we elucidate notifications related to full immunisation as per the schedule. Take the following table of children between 0 – 4 years old, diagnosed with pertussis:
Pertussis notification by vaccination status 0-4 years, Australia August 2011
We see that a total of 9,333 notifications have been tabulated. 5,296 or 56.7% are fully vaccinated.
986 are partially vaccinated. 800 are not vaccinated. 754 are ineligible for vaccination. This gives us a total of 2,540 or 27.2% who are not fully vaccinated.
1,497 or 16% are unknown.
Do these figures reflect infection in the community? No, they reflect the vaccine status of children diagnosed.
Firstly as the table informs us “fully vaccinated” does not necessarily conform with fully vaccinated under the National Immunisation Program. Ineligible cases between 6-8 weeks of age that had received one dose in 2009 are included in “fully vaccinated”. Both these facts artificially inflate the “fully vaccinated” category.
Next we must accept that this table underestimates the actual number of infections in the community. The National Notifiable Diseases Surveillance System relies on a passive surveillance system which does not capture every case of pertussis in the community.
Which raises the question. Who is not making notification? Can we infer anything about the vaccination status of those not recorded in the above table? If so, does this help us understand the figures in the table better? As a matter of fact, yes.
Do these figures reflect the efficacy of pertussis vaccination? In other words, is this telling us that there are over twice as many infected children in our community who have been vaccinated (56.7%), than those who have not been fully vaccinated (27.2%) and thus reflect low vaccine efficacy? No.
Far more children are vaccinated against pertussis than those who are not. 95% vs 5% in fact. Even with greatly reduced chance of infection the sheer numbers of vaccinated children mean that “fully vaccinated” will dominate notifications. These figures also reflect the greater likelihood of parents who vaccinate to take their child to a GP and follow through with reporting, and also reflect the likelihood of conscientious objectors to avoid a GP and to not follow through with reporting.
For example a USA study published in Vaccine in December last year showed that parents who do not vaccinate their children are four times more likely to take their child to a chiropractor than a conventional doctor. In Australia we already know that chiropractors are vocal antivaccination proponents with strong links to antivaccination lobby groups such as the Australian Vaccination Network. Many chiropractors in Australia actively mislead consumers on the topic of vaccination making impossible claims, actively deriding vaccination.
But we can do much better than this and begin to build a profile of parents who refuse vaccination and later choose conscientious objection. Five days ago Australian Doctor reflected on the study:
A US survey found parents who refused childhood vaccinations were four times more likely to have sent their youngest, school-aged child to a chiropractor than parents of vaccinated children. Parents who conscientiously objected to school immunisation requirements were also more likely to have strong concerns about vaccines, to distrust local doctors and to have had one or more births in a non-hospital, alternative setting. […]
Are naturopathic and complementary healthcare providers reinforcing parental concerns and ‘anti-vaccine’ opinions or promoting exemptions, or are they providing healthcare without emphasizing vaccinations?
The pattern emerging is one of anti-conventional medicine, reinforced by alternatives to medicine masquerading as “complementary healthcare”. For our purposes we must now accept that unvaccinated children may be up to four times less likely to visit a GP when ill with pertussis. This means they may be up to four times less likely to appear as a notification. Regardless of exactly how many unvaccinated children are missed, we can see with confidence that the total is skewed away from highlighting unvaccinated children.
Thus the 8.6% of unvaccinated children noted in the table above (n=800) is possibly a significant underestimation. As parents who do vaccinate are more likely to visit a GP and report diligently, the total is additionally skewed toward the fully vaccinated. What this actually means regarding community impact is best captured in this post written by a mother whose vaccinated child was infected by an unvaccinated child who had been sent to school.
Now comes the fascinating aspect. “Unknown”. What does this mean? Really? For whatever reason, somewhere along the line the child’s vaccination status is not recorded at all, is recorded and fails to make it to the final notification table or is lost to genuine confusion or poor record keeping.
However if parents are not registered on the ACIR as conscientious objectors or as completing their children’s vaccination schedules they are also listed as “unknown”. Thus the following from Brynley Hull and Peter McIntyre is compelling [bold mine]:
Additionally, the proportion of conscientious objectors on the [Australian Childhood Immunisation Register] ACIR is likely to be an underestimate of the proportion of parents who don’t immunise because they disagree with immunisation, particularly in more economically advantaged areas. There are some non-immunising parents who ‘object to registering’, and they will refuse to complete any government-provided form.
“Refuse to complete any government-provided form”. Such as those that question the immunisation status of one’s child? That also is where a significant number of “unknown” cases have their genesis.
In tandem with our emerging profile of anti-conventional medicine beliefs driving the decision to not vaccinate and combined with the observation that CO’s are likely to contribute to the “unknown” category by not registering on the ACIR, we are able to make a strong inference that unvaccinated out-rate vaccinated in this category.
Whilst it is impossible to make outright factual quantified claims and rewrite that table, we may conclude that placed in the context of community trends it gives a less than reliable indication of infected subjects within the community. What it does give us is a snap shot of the vaccine status of notifications. Placed in context those notifications appear to be skewed away from unvaccinated and toward vaccinated subjects.
The most significant reason is the overwhelming numbers of vaccinated children in the community. Although appearing as a notification they have a far less severe case of pertussis and are unlikely to suffer disability or death. Other reasons for this would appear to be the intentional avoidance or substitution of conventional medicine, diagnosis and reporting of vaccination status by those in denial of vaccine efficacy.
Of course, people will use these figures to attack the overwhelming evidence in support of vaccination. That’s just what eccentric parent Greg Beattie has tried. It’s simply gobsmacking to read his misleading claim that only 11% of pertussis infections aren’t vaccinated. Actually it’s only 8.6%.
But the point to be made is whilst only 5% of 0-4 year olds aren’t “fully vaccinated” they make up a disproportionate 27.2% of infection notifications. Unsurprisingly his novel mathematics have been dealt with unceremoniously by A Drunken Madman.
There is no debate here. Pertussis vaccination saves lives.
A most annoying non-sequitur logical fallacy, is the allusion to large or seemingly large numbers of adherents as proof something is genuine.
Whenever a pseudoscientist tries to hypnotise me with big numbers I’m reminded of Tony Ferguson and his scam weight loss programme sold in pharmacies. Following a scathing Choice review which included extra demerits for pushing it onto children, Ferguson declared, “600,000 People Can’t be Wrong but Choice Magazine can’t get it right with weight loss investigation!” And yes, if you remember the first part as his sales pitch itself you’re correct. 600,000 people can’t be wrong.
Well, 600,000 people were quite wrong if they were to all argue Ferguson’s magic shakes worked. That’s probably the first problem with this trick. Those figures come from signups and undoubtedly, in this case, the vast majority of that 600,000 had given no feedback and probably tried a number of fads before and since. To cut to the chase it’s a jump from sample size to claims of efficacy without bothering to do or document any science in between. We have no idea how many persisted, lost weight, kept it off or indeed ended up worse off.
Presently fundamentalist chiropractors are defending their hanky panky with the claim that 215,000 people across Australia visit a chiropractor every week. We don’t know how many are first time visitors, how many were unsatisfied, how many show no improvement, how many were injured, disabled or worse and so on. All it tells us is that 215,000 people per week visit these touchy feely agents of cosmic cockypop as part of their foray into alternatives to medicine. It also causes me quite some concern.
In removing insurance cover for the practice of neck manipulation (as reported by the National Council Against Health Fraud – Consumer Health Digest #10-34), popular US health insurer Kaiser Permanente revised their policy of coverage for chirpractic manipulation to read:
Chiropractic manipulation of the cervical spine is associated with vertebral artery dissection and stroke. The incidence is estimated at 1.3-5 events per 100,000 manipulations. Given the paucity of data related to beneficial effects of chiropractic manipulation of the cervical spine and the real potential for catastrophic adverse events, it was decided to exclude chiropractic manipulation of the cervical spine from coverage.
Now I shan’t apply the same logical fallacy and insist that at least 2.6 Aussies per week, or 10 per month, are at risk of “vertebral artery dissection and stroke”, because I have no idea how many are being, well, abused in this way. I also don’t know how accurate that figure is. I am quite sure however were I to put this to Chiropractors Association of Australia president Lawrence Tassell, he would quite rightly reveal the flaws in my reasoning.
He may even repeat the erroneous view of his immediate predecessor, Simon Floreani that the risk is 1 in 5.85 million (see Lateline video below). Quite a difference, and a figure described as “totally inaccurate” by Professor Roy Beran who published Serious complications with neck manipulation and informed consent in the MJA (2001) including deaths, stroke and other injuries from chiropractic neck manipulation.
His paper was:
…initially knocked back because it was so common knowledge and so frequent that the journal didn’t want to publish it
So all being fair the CAA are welcome to keep promoting their 215,000 patients per week visiting chiropractors, so long as we all accept the very same sales pitch should include Ten Vertebral Artery Dissections and Stroke per month.
Yet a concern of current critics increasingly involves the practice of paediatric chiropractic. Fundamentalists are taking it up in droves and at most appear to offer a light touch in a “clinical setting” to babies, gradually increasing the scope of manipulation with age. Of course the waving of hands over a small baby is an absolute scam. A goldmine given that we know trials have shown no visible effect. Chiropractors have invented “irritable baby syndrome” to revive what used to be called colic which ultimately emerged as an irritable baby, and no actual disorder at all.
Now their unproven rituals and adjustments of invisible subluxations are blessed with claims of “curing” or treating psychological conditions, improving immunity, croup, allergies, wheezing, pertussis, influenza, poor posture, stomachache, hearing loss, headaches, asthma, bedwetting, bronchitis, learning disorders, arthritis…. Soon I won’t even blink if ESP or Cosmic Consciousness makes it onto the list.
That’s only part of it. The level of mumbo jumbo that defies even basic science is close to frightening. Moderate infant complications are ramped to frightening levels as “deficits” are grossly misrepresented, paediatricians mocked and normal motor skill expression deemed a “neurological delay”. The claim that spinal adjustments improve total awareness because “all senses pass through the spinal column” is news to my ears… and eyes, and smell, and taste and vestibular balance.
Studies show that in blind trials, if parents believe the baby is being treated, they report improvement whether treatment took place or not. If told no treatment took place when in fact it did, parents report no improvement in their baby.
It may be expensive woo now but sooner or later, the USA trend of manipulating children’s necks will pick up pace in Australia. John Reggars (in the Today Tonight video), past president of the Chiropractors Registration Board of Victoria and present vice president of the Chiropractic and Osteopathic College of Australasia insists there is no evidence.
A read of Jeremy Youngblood’s death certificate gives insight into what those who stroke and die from vertebral tears brought on by cervical manipulation go through. It is doubly tragic given the view of Kaiser Permanente that there is a “paucity of data related to beneficial effects” in the first place.
In a case report review of serious adverse effects following cervical manipulation published by Edward Ernst in the eMJA in 2002 there is only one death amongst the multiple adverse outcomes. In this case it is a three month old baby and the practitioner is the sole physiotherapist listed. A physiotherapist practising Vojta Therapy which is in fact paediatric physiotherapy. The adverse event was:
Bleeding into adventitia of both vertebral arteries causing ischaemia of caudal brainstem with subarachnoid haemorrhage [and] death
The crucial point here is that regardless of profession, spinal manipulation of all types has been shown to carry significant risks. In 2001 Stevinson and Ernst published Risks Associated With Spinal Manipulation in the American Journal of Medicine, and note in the abstract:
Data from prospective studies suggest that minor, transient adverse events occur in approximately half of all patients receiving spinal manipulation. The most common serious adverse events are vertebrobasilar accidents, disk herniation, and cauda equina syndrome. Estimates of the incidence of serious complications range from 1 per 2 million manipulations to 1 per 400,000. Given the popularity of spinal manipulation, its safety requires rigorous investigation.
In fact according to this RCT published in the Lancet there is no difference between manipulation or placebo when it comes to recovery from low back pain. Physiotherapists confident in spinal manipulation carried out the trial. As Chris Maher says in the Lateline video below recovery rates were almost “exactly the same”. So basically, there’s good evidence to suggest a 50% chance of sustaining an injury to any part of the spine undergoing a procedure not shown to be any more effective than placebo, when the low back is involved. Serious complications and death apply to manipulation of the neck. There is no evidence supporting application of the latter.
As reported by John Dwyer, Emeritus professor Uni NSW, the literature contains 700 cases of adverse reactions in children following chiropractic adjustments. Given the danger of all spinal manipulation, the copious numbers of adverse effects from vertebral manipulation and the inherent danger of paediatric manipulation, chiropractic faces an uphill battle in the eyes of evidence based treatment.
Added to this however, is the rapid rise of the fundamentalists, who I prefer to call the Mystic Chiropractors. Their disillusioned appreciation of conventional medicine and aversion to supporting it is nicely summed up by Lawrence Tassell on the topic of vaccination. From Adelaide Now:
He also dismisses suggestions chiropractors are anti-immunisation.
“We don’t recommend for or against vaccination; we simply say it’s a choice factor,” he says.
Which is of course, the anti-vaccination cover. Who would choose to risk their child’s life when availed of all the evidence? Yet when fed misinformation and outmoded fear mongering vaccination may seem like a “choice factor”. Chiropractors are misleadingly allowed to use the title “doctor”. They still make up the bulk of the “professional” members of the Australian Vaccination Network. In 2009 Floreani and Tassell’s CAA had a grand aim:
To achieve a fundamental paradigm shift in healthcare direction where chiropractic is recognised as the most effective and cost efficient health regime of first choice that is readily accessible to all people
Reggars claims the “all-encompassing alternative system of healthcare is both misguided and irrational”. He’s exposed the money angle informing us:
Chiropractic trade publications and so-called educational seminar promotion material often abound with advertisements of how practitioners can effectively sell the vertebral subluxation complex to an ignorant public. Phrases such as ‘double your income’, ‘attract new patients’ and ‘keep your patients longer in care’, are common enticements for chiropractors to attend technique and practice management seminars.
Selling such concepts as lifetime chiropractic care, the use of contracts of care, the misuse of diagnostic equipment such as thermography and surface electromyography and the X-raying of every new patient, all contribute to our poor reputation, public distrust and official complaints.
This video by the Council on Chiropractic Practice refers to, “the Dark Side of the profession… keeping the imprisoned impulse captive… and [its] innate potential chained”. What’s it mean? Those who reject the made up notion of “subluxation” are the dark side and as the video states the “right to treat it” is under attack. Sound familiar? It seems the theme of having a right to apply demonstrably dangerous beliefs and practices at the expense of genuine medical intervention is “a right”.
What’s insane about chiropractic is that it’s assumed everyone needs treatment. Their impulse is “imprisoned” along with its “innate potential”. The only result of pursuing this potential offered by the “science that makes everyone well and happy” is certain loss of money and a definite risk of injury, disability or death. Palmer’s 19th century superstitious and completely subjective “God given energy flows” are today’s “very principles this profession was founded on”.
CHIROPRACTORS are peddling shonky treatments that could be dangerous for people, including babies and children, a group of high-profile doctors says.
In an extraordinary attack, 34 professors, doctors and scientists issued a statement yesterday calling for more policing of chiropractors’ false claims and said the federal government should not fund chiropractic courses at Australian universities because it gave their ”pseudoscience” credibility.
The group, which includes the president of the Australian Medical Association, Dr Steve Hambleton, and head of public health at Monash University Professor John McNeil, said although some chiropractic treatments had an evidence base, claims it could cure 95 per cent of ailments was nonsense. […]
In a letter to Central Queensland University protesting against its recent inclusion of a chiropractic course, the doctors said they were also concerned about chiropractors being the largest ”professional” group in the anti-vaccination network.
One of the signatories, Professor of Neurophysiology at Flinders University Marcello Costa, said universities running such courses were encouraging the spread of quackery, misusing public money and delaying effective treatments for people who falsely believed chiropractors could cure their illnesses.
Exactly why these cosmic cuddlers assume they have a right to bring about a shift in the direction of healthcare that is overflowing with pseudoscience and risk, so they can profit, is well beyond my ethics tolerance threshold. Added to the defensive battle posture they have taken up against the “attack”, that is in reality a request for proper evidence on the magic of subluxation, a distinct malignancy is in the air.
Chiropractors aren’t treating you. You’re treating them to a free ride at risk to yourselves and your loved ones.
Losing In The Lucky Country 