Shaun Holt on iridologist Ruth Nelson's treatment of cancer patient Yvonne Maine

By Grant Jacobs 06/09/2012 23


Wellington professor of medicine, Shaun Holt, recently spoke to Radio Live about the Health and Disability’s Commissioner’s report into iridologist Ruth Nelson’s treatment of cancer patient Yvonne Maine:

One of the topic he raises is what might be done to avoid these cases from arising. Dr. Swee Tan, the surgeon who treated Mrs Main, suggested a registration scheme. I had mixed feelings at that:

My own thoughts, as a non-medical person-on-the-street, are that in one sense registration might legitimise the more moderate use of ’remedies’ like iridology, which grates given that many, if not most, of these remedies are nonsense under any use, but on the other hand registration offers some control over the worst extremes of misuse by obligating practitioners to adhere to guidelines.

Shaun felt there was no sense in registering practices that don’t work, comparing it to registering psychics. Instead he felt that the law should be used where practitioners make fraudulent claims or harm someone, including contributing to someone’s death.

Update: I have corrected the patient’s name from Main to Maine. My error stems from taking her name from the on-line copy of an article by the NZ Herald, whose first instances of her name (twice; once in body text and once in a illustration legend) are, it seems, incorrect. My apologies for the error.

Footnotes

I’ve lifted this from Shaun’s comment in my previous post on this topic to to give it a little more attention. (Also, partly to buy some time while I try prepare a post with some thoughts on the ENCODE genome analysis work that has been published over the last day – this is, apparently, 30 research papers published at once; there’s a lot to take in!)


Other article in Code for life:

Homeopathy in NZ pharmacies revisited: Wartoff and more

Time for disclaimers on remedies?, “alternative” or not

Genetic tests and personalised medicine

Genetic tests and personalised medicine, some science communication issues

Deleting a gene can turn an ovary into a testis in adult mammals


23 Responses to “Shaun Holt on iridologist Ruth Nelson's treatment of cancer patient Yvonne Maine”

  • As to this, people presenting for care do have some protection under the HDC system, with all practitioners having to adhere to the Patients Code of Rights – http://www.hdc.org.nz/the-act–code/the-code-of-rights. This however can be a bit toothless, and the HDC can sometimes bring in others in the same field to comment on practice such as diagnosis and treatments offered. This works where standards exist, like dentists, nurses and doctors but can fail miserably when it’s quackery. With the report on the iridologist, it’s clear they expected that some standards would be adhered to, but even whether she had any qualifications is in question. Maybe it’s that system that could be improved, it would be good if they could order more than a apology, and possible referral to the Director of Proceedings if extreme negligence (I think criminal charges may be laid, but I’ve never seen it done for a quack). I’d like them to be ordered to compensate for harm and suffering, and perhaps have some power to at least make a ‘cease and desist’ practicing order.

    I don’t think nonsense therapies and quackery should be registered, what I’ve noted is this gives them official legtimacy but fails to protect patients. With registered health professionals, this works because the training, code of ethics and standards of practice are consistent for all and most importantly, the standards require they work within the bounds of available evidence for practice. That’s not the case with iridologists and their ilk, even if the “training” was standardised, it’s based on false ideas and there is no hope for setting standards. Register nonsense and you’ll still get nonsense but people seeking care will see them as viably offering care, and the there are known risks to this, including deterring or delaying people from seeking appropriate medical care.

    It’s complicated. I don’t find Dr Holt particularly compelling in the area of so-called alternatives to proper medical care, even though what is said here is probably entirely correct. This probably sounds silly, but I think Tim Minchin is right, if it works it’s just medicine, none of this of alternative therapies that really work stuff should apply. If it worked, our GP’s be using it and it’s just keeping one foot in each camp otherwise.

  • I agree that the term ‘alternative’ doesn’t really make sense and plays on word meanings. Either treatments work or they don’t. I haven’t read Holt’s books so I can’t offer an opinion on them.

    Just a twist on a theme, or perhaps a spanner in the works (trying to pick my hackneyed phrase here!), what should we make of GPs who offer woo. I know for example of GPs advertising homeopathy on their webpages.

    Readers might also see Hemlock’s earlier comment on the other thread.

  • I think one place we should really and aim our darts at is NZQA. They are the institute who can legitimise anything. If you present course work, quaility systems, level standards, (alleged) need, then you will get NZQA approval for your course. Then the organisation who has “passed” can legitimately say “Approved by NZQA” anywhere they like and be called NZQA Providers.

    Check out the pages of courses that have been accepted. eg Homeopathy, astrology, colour therapy are examples.

  • Ross,

    “Check out the pages of courses that have been accepted. eg Homeopathy, astrology, colour therapy are examples.”

    Will check this later. How on earth do you approve things that themselves are at kindest unsubstantiated and more accurately complete bunkum?

  • Grant, I would suggest the answer to the question on why these “alternative” treatments are approved is because there is demand for it.

  • Hi Michael,

    My question was rhetorical. I’m not sure if you’ve got my message, though; I’m aware there is a demand, of course – it’s unfortunately hard to miss! That something is popular doesn’t in itself make it logically correct for them to approve it – it’d be the argumentum ad populum fallacy in action – i.e. them working as a ‘blind’ rubber-stamping organisation that doesn’t care what the qualifications are for, and if those practices should be recognised as creditable, as long ‘enough’ people ‘demand’ it. (It’s self-evident from Ross’ list that they do approve of things merely ‘on demand’ – hence my rhetorical question.)

  • Grant, I get your point but I think it is a mistake to think that approval of these courses of study is driven by logic.

  • Hey guys –

    “but I think it is a mistake to think that approval of these courses of study is driven by logic.”

    – that it’s not driven by logic was what I was pointing out.

  • “I don’t find Dr Holt particularly compelling in the area of so-called alternatives to proper medical care, even though what is said here is probably entirely correct.”

    I’m not sure what Hemlock means by this – I spend most of my time debunking quackery in the media, in original research and in the 50 talks a year I give. And if there are therapies classified as “complementary” that are sensible and supported by good evidence, I advocate them.

    My fellow doctors are mostly not aware of which complementary therapies have a good evidence-base, which is why they ask me to teach them, so the argument that if it worked doctors would recommend it is not true. One of the main reasons is that there is so much nonsense, any useful therapies get hidden among them.

    When others are calling for regulation of quacks and I’m calling for jail-time – I would have thought that was compelling!

  • Grant: You may remember I sent you a copy of an ACC OIA request asking about how much ACC spends on complementary medicine, chiropractic, acupuncture etc.

    The spend has been increasing over the top for the last 5 or 6 years.

  • Ross – was thinking that with Close Up babbling away in the background. I’d want to chase up updated figures, though.

    I wish the production team would think about how they present text – it’s stupid panning over it in a way that people can’t read it for the sake of trying to create ‘drama’.

  • Ross – there’s a place in our suburb that offers *cupping* on ACC. Does ACC actually look for evidence of efficacy before deciding to fund this stuff?

  • So, from your link: Evidence based reviews are assessments of the effectiveness and safety of therapies, medicines or other health interventions. They developed according to a robust methodology similar to that used by the UK Centre for Evidence Based Medicine. This includes systematic searches of the literature, critical appraisal of existing research evidence and peer review by clinical experts.

    And the critical appraisal of cupping tells us what, exactly? If I can find the time I might chase that question up…

  • I got into the ACC because they stopped using an Otago University Falls Prevention Programme. A programme developed with experiments, data and solid conclusions. This was a one to one method of teaching the elderly how to go about their daily chores by informing them of the hazards they will be encountering as they get less efficient walking around. It had a well documented success rate.

    It was replaced by Modified Tai Chi. Group therapy, able to held in one place for the multitudes. The only figure – and I emphasis – the only figure I could find was a bald statement that claimed, unsurprisingly, a higher success rate (47% reduction) than the Otago method (35%). ACC were unsuccessful in giving me similar evidence and just pointed me to a report* by Stephen L Wolf.

    The reason for the Otago being dropped: It wasn’t cost effective. ACC claimed a return of $0.23 for every $1 invested. Hmmmm. Sad.

    *Report: Reducing Fraily and Falls in Older Persons: An investigation of Tai Chi and computerised Balance Training. Stephen L Wolf.

    and others supplied by ACC:

    An evaluation of ACC’s Modified Tai Chi Programme for older adults – Full Report, NZ Tai Chi Research Group. AUT.

    Optimisation of ACC’s fall prevention programmes for older people – Final Report, Nov 2008. Otago Uni.

    Supply of short term evaluation of the modified Tai Chi programme – Final Report. UMR Research.

    A randomised, controlled trial of Tai Chi for the prevention of falls: The Central Sydney tai chi Tria. Alexander Voukeltos, Robert G Cumming, StepehnR Lord and Chris Rissel.

  • Something similar from overseas: http://www.unm.edu/~lkravitz/Article%20folder/taichi.html

    But one is forced to wonder – why tai chi? Why not any form of regular exercise involving all core body areas? Did the individuals in the program know of its purpose? (The methodology doesn’t say.) And it was self-reported – was there any attempt to triangulate this with data from eg public health nurses or GPs?

    As for the cost-effectiveness of the Otago program – I’d want to know the actual cost of having someone who was previously living independently, hospitalised or in institutional care as the result of a fall. Presumably ACC base their claimed return on such data?

  • BTW. In 2007 I asked Minister Ruth Dyson if there was any truth to the rumour that ACC was buying magnetic underlays for clients. In a very round about way she said they did. She then assured me that ACC were telling ther providers that magnetic underlays would no longer be funded. She went further:

    “However, ACC has decided that further research into the efficacy of these magnetic undelays is needed. All ACC staff have been advised to cease purchase of these underlays, until such time that this research is completed. On completion of this research it will be clearly determined whetehr these magnetic underlays come within the bounds of ACC’s rehabilitation policy.”

    That was a wee success.

    However, after my OIA request, in the ensuing email discussion, I asked if Minister Dysons answer was still operative. The reply:

    “In regards to your comments on magnetic underlays, ACC has not made any specific policy or instruction to fund magnetic underlays, nor has there been any specific instruction to cease funding these items”.

    It IS good to know they are spending our money wisely.

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