Part 1 of Paul Smith's 'investigation' - part 2 to follow (LONG)
Posted: Thu Apr 21, 2011 8:24 am
Here is a 3 part article just recently published in Australian Doctor.
It is worthwhile reading to be aware of the political changes that are coming, driven by either poor practices and standards OR skeptic organisations out to squash alternative therapies, homeopathy in particular.
I will send part 2 in a following email.
AN AUSTRALIAN DOCTOR INVESTIGATION: Political editor PAUL SMITH ventures into the world of complementary and alternative medicine.
I’M sitting on a chair at the back of a crowded suburban vitamin shop, my glasses off. Crouching beside me, a man called Peter is holding a large yellow torch — the sort used by the NRMA during night-time breakdowns — and he’s shining it into my eyes while a woman called Lou does the examination with a magnifying glass.
A small, intense woman dressed in black, Lou doesn’t say much. Her face is all concentration. “Open them wider.” Peter, taking on the assistant role, shifts the light as she moves in.
Once finished, she turns away and, on a sheet of A4, sketches out a rough diagram of my eyeballs. At the edges, with a blue biro, she scribbles dark lines labelling the problems associated with different parts of the irises — anxiety, a pancreatic bulge and mental exhaustion.
“You are always thinking,” she says. “Your mind is always active.”
Over her shoulder, the vitamin store is hectic. The numerous punters are squeezed tight next to shelves stacked with thousands of coloured bottles and plastic containers, stuffed with every conceivable over-the-counter remedy from olive leaf immune support and gatu kola to scarless healing cream and half-priced tubs of Bowel Calm, for the relief of “spasm and flatulence in the gastrointestinal tract”.
The store’s size and evident popularity are tangible evidence of the insatiable demand fuelling Australia’s alternative therapy boom. It’s now worth an estimated $3 billion a year, almost doubling in a decade. It has been claimed that one in six Australians rely on complementary and alternative practitioners as their primary carer. And alternative therapies have been embraced by private health insurance companies, taught as university degrees and accepted by governments.
But this industry has also been dubbed the ‘black market of healthcare’. Much of it remains untouched by regulation, its practitioners often free to work with no training, administering scientifically bizarre therapies with little evidence for either efficacy or safety.
At the extremes, individual practitioners have attained such status they have been embraced by the sick and seriously ill — even those on the verge of death — in ways that sometimes end with horrific but ultimately pointless suffering. But even at another level, the legitimacy afforded alternative therapies, and their acceptance as legitimate paradigms, means the industry now has a cultural force that to its critics, is slowly eroding the wider public’s trust of conventional medical practice.
My brief venture into this world with a genuine health complaint — insomnia — is my attempt to understand that legitimacy, at least that held by the millions who use it.
Lou, a naturopath employed by the shop, is my first appointment.
After the eyeball sketch is complete, she says: “You’ve got an anxiety digestive iris type. You can see it from the orange brown colouring in the iris.”
She suggests I have problems regulating insulin. The result, as far as I understand her, is episodic hypoglycaemia induced by a carbohydrate-centred eating cycle I’ve adopted to alleviate anxiety. She doesn’t ask for a medical history — for her it’s all in the eyes.
She points to another biro scrawl down the side of her eyeball drawing.
“You have problems with the male voice,” she concludes. “You don’t like the male voice. It’s about problems with male relationships.”
She suggests I may have heard these male voices as a child or even in utero — my dad shouting at my pregnant mum — but that my mind may be “fogging” the memory to block the trauma.
This unpeeling of my psychological repressions takes place while the shoppers grab her for advice and information.
“Can you have a look for her, Peter,” she says. It’s the brusque tone of a woman working the natural therapy version of an ED.
During my diagnostic report her voice drops to a whisper only once — after she raised the possibility of future prostate problems, she softly utters the words, “you may also get sexual problems” — looking up to check no one is in earshot.
In the store, customers walk around clutching small bits of folded paper. On these folded slips are names of various pills and potions. These are ‘prescriptions’ written by the shop’s naturopaths who discuss ailments and suggest treatment options. They offer explanations of the body’s working, suffused with the language of folk biology.
“It helps strengthen the lymphatic system, so you won’t get that mucus.”
An elderly woman in her late 60s, following a quickie iridology assessment in front of the cash register, brings out her purse. Four bottles are scanned in.
“One-twenty, 45, thanks.” She hands over cash and a credit card and then rummages in her purse for a store loyalty card. One-twenty, 45 — $120.45.
My prescription is a fraction of that cost. Lou suggests 5 HTP — described on the pack as a “neurotransmitter support” — which I am to take orally. The packet says it “supports positive mood”, with a small asterisk pointing to a FDA disclaimer.
Then there’s St John’s wort and the vitamin industry’s pill du jour, magnesium chelate. The bill is just $49 but I didn’t take up Lou’s suggestion for a probiotic, amino acid or enzymes. She doesn’t mind. There is no pressure, even though she’s spent 15-20 minutes with me — including the free iridology.
Time and money
A couple of hours later, I’m on the phone to a man whom I’ll call Mr Dodder.
I’ve been told he charges $100 for a consultation and I’m slightly shocked that he rates his skill so highly. I phone to check.
“One-hundred dollars should be the fee,” he says brightly. “But it’s $70. That is a ridiculous amount. It’s a last-century price.”
Mr Dodder’s name is followed by ND, D Nut and many other acronyms I don’t recognise.
He is keen to prove he’s value for money when I mention my ailment.
“It will take the full hour,” he reassures me.
The address he gives leads to a lift at the back end of a shopping complex. The lift doors slide open and I walk along corridors past a line of fibro offices to the clinic.
The waiting room is empty. There’s a card on the reception desk listing the clinic’s therapeutic modalities — reiki, homeopathic medicine, naturopathic medicine, lymphatic drainage massage and Feldenkrais. But there is no Mr Dodder.
I ring the bell and it’s five minutes before he appears from behind a door.
“Paul? I’ll be with you soon.” He’s a fit-looking, middle-aged man. He’s dressed smartly — shirt, tie, slacks and trainers.
I’ve not been sleeping well, I tell him. I don’t know much about naturopathy but I’m willing to give it a go. I tell him I don’t feel that the problem is so great I need a doctor to prescribe sleeping tablets.
“You are referring to allopathic techniques?”
“Sorry, what?”
“Allopathy.” Then he writes the words on the paper in front of me and circles them for emphasis: “allopathy”, “homeopathy”, “naturopathy”.
“Allopathy is what is considered mainstream medicine. It means ‘against the body’. That’s what it is. You know, ANTIbiotics, ANTIdepressants. Homeopathy, on the other hand, is ‘with the body’, not against it.”
Mr Dodder goes on to explain his approach. Again on the paper he draws: a triangle for “underlying cause” and a circle on top of the triangle to represent “symptoms”. The principle, he says, is to deal with the “underlying cause”, not just the circle.
“It’s not about this,” he says, stabbing a finger at the circle. “You understand?”
I’m not sure how this differs from the practice of every doctor in the country, but he warns that his techniques will require some time. I have to provide him with enough information on possible underlying causes to fill the five blank pages of A4 paper lying on the table. It’s on this basis that he will be able to offer therapeutic suggestions.
“It could be your bed, it could be your pillow.” So we discuss pillow thickness. I say I think it’s average.
“There’s no such thing as average,” he declares.
He walks over to his consultation couch and picks up a pillow. He looks at me with the smile of a man who’s about to prove his point, Sherlock Holmes-style. I take the pillow and squeeze.
“Mine is slighter thicker,” I admit.
We discuss whether I sleep on my back or on my side and which side, and whether I know which side I sleep on at the point of going to sleep. He wants me to find out.
We discuss what I think about when I go to sleep. Normal stuff, I say.
We go on to explore changes in my life over the past nine months that may have triggered the change in my sleeping patterns. My work, my family. We discuss my elderly parents and my fears about them dying and he writes this in his notes.
At one point he lifts the sheets of paper to show how much we’ve learnt about potential underlying causes through the holistic approach. He looks pleased.
Halfway through, the phone on his desk rings.
“I’m going to change my voice. It’s from overseas.” Unsure why he’s going to change his voice, I figure it’s a professional consultation with a patient so try to look away.
“Yes ... Yes ... Yes…”
After a minute of silence he finally says: “Will you remove my number from your directory … Will you remove my number from your directory ...WILL-YOU-REMOVE-MY-NUMBER-FROM-YOUR-DIRECTORY!”
Then, using two hands, he gently replaces the phone back on the hook.
“Sorry about that.”
“An Indian call centre?”
He ignores me.
At various points during the consultation, Mr Dodder stresses his reluctance to prescribe his treatments, which are apparently compounded by a local pharmacist and sold by Mr Dodder for $15 a pop.
“Look, I’m not going to do what mainstream doctors do — take a drug off the shelf, give it to the patient, take another drug off the shelf give it to the patient."
Holistic natural therapy is about tailoring specific treatment to the specific needs of the specific individual, he says. But progress is slow.
About 50 minutes in, with the outside darkness closing around us, he says we haven’t got to the underlying cause. “I don’t feel there is anything I can do based on what we’ve got here.”
Conscious that time is getting on and that I’ve got to come up with more possible underlying causes to fill the five pages, I get a feeling in my stomach. It’s the desperate feeling of a small boy kept behind after school until he names names.
I mention a relaxation technique I use — controlled breathing when sleep won’t come. He asks what I’m doing, and when I describe it he tells me the technique is wrong.
“You don’t breathe in through your mouth, never breath through your mouth. People do it all the time and then we wonder why we’ve got such high rates of asthma in this country.” Mr Dodder shakes his head in disbelief.
Breathing in through the nose, he says, is much better because it humidifies the air, allowing the nose to cleanse the air before it goes into the body, thereby preventing infection and mucus.
He instructs me on a four-part breathing exercise that will “reduce the carbon dioxide in my brain”. It involves inflating the abdomen and then lungs, and then deflating the lungs and then the abdomen.
“Can you feel it here,” he asks, pointing at his forehead. “I feel more relaxed already,” he says, with genuine pleasure. The tension finally eases for me too.
I ask how he decides which techniques to use, given his skills in so many areas of alternative therapies.
“You know, how do you decide whether you are going to use crystals or some other tech…”
“Crystals!” He stares hard at me. “We don’t do anything with crystals or aromas or anything like that. We are traditional therapists trained in traditional techniques.”
At end of the consultation, I pay the money ($70) and he picks up a digital clock from his desk showing it’s 6.20pm. It’s been over an hour.
“I’m not charging you for an extended consultation,” looking very pleased with himself. Future consults are $80, with a $40 fee for any cancellation with less than 24-hour notice. He only takes cash or cheque.
That night in bed I stare into the darkness, worried that I have given a strange man I’ve never met before my family address and phone number. I don’t sleep.
Confessions
Alongside the climate change sceptics, the faith healers, the antivaccine campaigners and the intelligent design defenders there sits another abuser of evidence-based practice — newspaper feature writers, believers in the power of n=1 narratives to give meaning to the statistically meaningless.
It’s no different here, I confess. My biggest worry before I left the office for my appointments with Lou and Mr Dodder was what I would write if the iridology and naturopathy did actually soothe and heal.
So, I can only plead the subjective “facts” established by this self-interested participant. First, Lou’s diagnostic account flirted with the truth before plunging off in some Freudian psychobabble about in utero imprints.
The “pancreatic bulge” — that was close to the established truth. I thought for a moment she was going to diagnose from my “anxiety depressive iris type” the type one diabetes I’ve had since 1991.
Insulin regulation is an issue, she said, and she was right — although whether her belief that the morning Weetbix was leading to a cycle of hypoglycaemia could be disputed. And the pills she prescribed, especially the St John’s wort: there is evidence that they work in the treatment of depression.
With Mr Dodder, the therapeutic relationship was fraught almost from the beginning. Perhaps we clashed because I struggled to believe in him. I guess that happens to a lot of health practitioners. He didn’t take a proper history, despite his commitment to holistic treatment. But to be honest, I was relieved. I wanted out of the room.
However, Mr Dodder was true to his word. He didn’t prescribe any “medication”. And the breathing technique was relaxing, even if it didn’t succeed in making the $70 fee seem good value.
I must also add that he was strictly kosher when I told him about my diabetes. Insulin therapy didn’t offend his homeopathic principles. He left it alone.
Among the undecided
Across Sydney is the Newtown Community Chiropractic clinic, the last stop on this brief tour of the alternative medicine world.
I’m there on a wet and humid Saturday afternoon to listen to a talk by a bearded, but clean-cut, man in his late 30s called Nimrod Weiner. For the next two hours it will be Nimrod’s job to inform us on the safety and efficacy of what is generally regarded as medicine’s greatest gift: vaccines.
In an upstairs room, as the ceiling fans twist slowly above, are 30 or so people whose profile probably fits the current Newtown demographic — young, educated, alternative; the kind who don’t use plastic bags, don’t deny climate change and don’t tune in to Alan Jones. Here, among men wearing Che T-shirts, are mums with bubs swaddled to their chests and women at the point of pregnancy where it’s best to offer them a seat.
The woman next to me asks if I’ve got kids, if that’s the reason I’m here. She looks down at her baby bump. “I’ve been procrastinating. I’m undecided. I want to pick and choose. I just don’t want to be a sheep, you know.”
For the next two hours, from the moment Nimrod starts to talk, she takes notes.
Nimrod, a chiropractor whose website says he has a masters in paediatrics, tells us early on this isn’t going to be a rant on an issue that has become politically and emotionally charged. He’s here today, he says, to provide a fearless appraisal of the hard science.
“One of my roles, apart from working in this practice, is that I sit on the board of the Spinal Research Foundation,” he says. “What that means is that every day I am reading a lot of research articles. I’m good at knowing how to read a research article, I know whether it’s viable or not. I’m also good at collecting that research. What that means is that this is right up-to-date.”
As he starts to walk the floor, backed up with his slide presentation, he provides an overview of the immune system, and lists the kinds of things that make up vaccines. He includes emulsified peanut oil, aluminium, thiomersal, formaldehyde and then throws in a line about manufacturers growing the chickenpox virus on aborted foetuses.
He must sound convincing. At least, no one questions him. But the claims — which include “no vaccine study has been done on safety around the world by anyone but the drug companies” — are often stripped of both context and of the qualifiers you hear when academics discuss their work.
Nimrod also talks a lot about “links” and “connections”. I’m figuring that the audience, for all their education, may be missing the subtleties of the language, the statistical distinctions between weak links and strong links, and the distinction between association and causation — the things you learn when you discover the wonders of P values.
For me it all falls apart when he gets to the MMR–autism controversy. The first name he mentions is Wakefield, the UK doctor struck off after his fraudulent 1998 paper helped fuel media panic and a slump in the country’s vaccination rates, resulting in rising measles rates every year since 1998.
Nimrod begins as a paragon of scientific disinterest.
“I want to state there is good evidence and bad evidence on both sides [on the link between MMR and autism]. I want to present the scientifically valid research that is out there on this issue.
“A lot of people have heard about a famous case with a medical doctor in Britain called Dr Wakefield, who published back in the BMJ about a possible link between autism and mercury in MMR and has been deregistered. My feeling is, and I have read the study, is that the study itself is scientifically good.”
There is one bloke in the audience with a bundle of sheets printed off the internet. And he lays down the challenge. First he corrects Nimrod — Wakefield’s research was published in the Lancet not the BMJ.
Then the questioner starts listing studies — negative and positive — drawn up in the aftermath of the saga, as scientists attempted to offer the world a detailed picture of what the science said. “There is a hugely greater number of negative [studies] than positive,” the man says.
Nimrod responds by referring to the “hierarchy of evidence” in peer-reviewed journals.
“But you think the Wakefield research was good?” I ask.
“The Wakefield study showed there was a connection between MMR and autism,” Nimrod says. “Some of his ethics were questioned and a lot of the other co-writers have removed themselves from that study and the BMJ [he means the Lancet] has retracted that study itself.”
He doesn’t tell us that Wakefield’s paper was on just 12 kids, or that it doesn’t actually claim a link between autism and vaccination—Wakefield made that link later when talking to journalists.
He does mention the BMJ editorial this year that made further allegations against Wakefield. But again he does not tell his audience about the editorial’s conclusion: that the “clear evidence of [Wakefield’s] falsification of data should now close the door on this damaging vaccine scare”.
Nor does he relay the fact that the BMJ accused Wakefield of being “so incompetent that he was unable to fairly describe the project, or to report even one of the 12 children’s cases accurately”.
The man falls silent, the printouts only take him so far. Nimrod keeps going, unperturbed. He’s not dogmatic. He wants to convince. And he throws in good advice on breastfeeding and healthy eating and the importance of questioning doctors and not being a sap to their authority just because they want to boss you about.
And Nimrod, it’s important to stress, is rarely directive. The only vaccine he explicitly urges us against is hepatitis B — and vitamin K injections in newborns.
Occasionally someone chips in. One woman talks about the influence of the "trans-global drug company cartel" and then offers an account, spoken in horrified tones, on the risk of cross-species infection involving monkeys.
"I've heard that in certain vaccine there are viruses from monkeys and chickens," she says. "We listened to the Australian Vaccination Network. We asked a question and the lady said 60 different rogue viruses were linked to the chicken pox vaccine."
When Nimrod eventually gets to the herd immunity concept, it turns out he believes it logically flawed.
"It is a theory that really doesn't make sense," he declares. "If I say vaccines are effective and they are able to protect my child, if all of you vaccinate your child and I don't, if my child comes into the surroundings then your child should be protected. Either vaccines protect my child or they don't protect my child. You have to stick with one logical resolution."
Again the man with the printouts -- a sole questioning voice -- fights back: "It's like wearing seatbelts. They can't guarantee I won't die in a car crash. But it reduces my risk. [The virus] can't propagate in the community because there are too many immune people out there."
Nimrod: "But if you come into the contact with the bug, you're going to be exposed to it whether you have been vaccinated or not. People around you who have not been vaccinated or been vaccinated, are not going to protect our body."
The man falls silent - so Nimrod moves on to the idea that some of the infections we vaccinate against are not that bad. Chicken pox "makes you uncomfortable", he says, but it is usually not dangerous and it's better for the body to generate its own immune response naturally.
He's silent on polio and whooping cough and it is notable that his Apple Mac slide show includes no pictures of kids with smallpox.
He ends the talk, referring to the wonders of chiropractic care, the way it uses modern computer technology to identify stresses and offering us discounts on first consultations.
Once it’s over, I go up to him to tell him I’m writing a story and want to use his presentation. I tell him I work for a magazine called Australian Doctor and expect him to start railing against the wrongs of the medical profession in the vaccine saga.
It turns out he claims he’s done five years of a medical degree.
“But why are some chiropractors choosing to inform the public about vaccinations?” I ask.
“What do you think?”
“I don’t know.”
“It’s about people’s health,” he says.
--
Kind regards,
Fran Sheffield
Homeopathy Plus! (Tutorials - Remedies - Immunisation)
http://www.homeopathyplus.com.au
Do No Harm Initiative (Free Information on Homeopathic Immunisation)
http://www.d-n-h.org
Homeopathy for Autism (Guidelines for Treatment - Search for Practitioners)
http://www.homeopathy4autism.com
It is worthwhile reading to be aware of the political changes that are coming, driven by either poor practices and standards OR skeptic organisations out to squash alternative therapies, homeopathy in particular.
I will send part 2 in a following email.
AN AUSTRALIAN DOCTOR INVESTIGATION: Political editor PAUL SMITH ventures into the world of complementary and alternative medicine.
I’M sitting on a chair at the back of a crowded suburban vitamin shop, my glasses off. Crouching beside me, a man called Peter is holding a large yellow torch — the sort used by the NRMA during night-time breakdowns — and he’s shining it into my eyes while a woman called Lou does the examination with a magnifying glass.
A small, intense woman dressed in black, Lou doesn’t say much. Her face is all concentration. “Open them wider.” Peter, taking on the assistant role, shifts the light as she moves in.
Once finished, she turns away and, on a sheet of A4, sketches out a rough diagram of my eyeballs. At the edges, with a blue biro, she scribbles dark lines labelling the problems associated with different parts of the irises — anxiety, a pancreatic bulge and mental exhaustion.
“You are always thinking,” she says. “Your mind is always active.”
Over her shoulder, the vitamin store is hectic. The numerous punters are squeezed tight next to shelves stacked with thousands of coloured bottles and plastic containers, stuffed with every conceivable over-the-counter remedy from olive leaf immune support and gatu kola to scarless healing cream and half-priced tubs of Bowel Calm, for the relief of “spasm and flatulence in the gastrointestinal tract”.
The store’s size and evident popularity are tangible evidence of the insatiable demand fuelling Australia’s alternative therapy boom. It’s now worth an estimated $3 billion a year, almost doubling in a decade. It has been claimed that one in six Australians rely on complementary and alternative practitioners as their primary carer. And alternative therapies have been embraced by private health insurance companies, taught as university degrees and accepted by governments.
But this industry has also been dubbed the ‘black market of healthcare’. Much of it remains untouched by regulation, its practitioners often free to work with no training, administering scientifically bizarre therapies with little evidence for either efficacy or safety.
At the extremes, individual practitioners have attained such status they have been embraced by the sick and seriously ill — even those on the verge of death — in ways that sometimes end with horrific but ultimately pointless suffering. But even at another level, the legitimacy afforded alternative therapies, and their acceptance as legitimate paradigms, means the industry now has a cultural force that to its critics, is slowly eroding the wider public’s trust of conventional medical practice.
My brief venture into this world with a genuine health complaint — insomnia — is my attempt to understand that legitimacy, at least that held by the millions who use it.
Lou, a naturopath employed by the shop, is my first appointment.
After the eyeball sketch is complete, she says: “You’ve got an anxiety digestive iris type. You can see it from the orange brown colouring in the iris.”
She suggests I have problems regulating insulin. The result, as far as I understand her, is episodic hypoglycaemia induced by a carbohydrate-centred eating cycle I’ve adopted to alleviate anxiety. She doesn’t ask for a medical history — for her it’s all in the eyes.
She points to another biro scrawl down the side of her eyeball drawing.
“You have problems with the male voice,” she concludes. “You don’t like the male voice. It’s about problems with male relationships.”
She suggests I may have heard these male voices as a child or even in utero — my dad shouting at my pregnant mum — but that my mind may be “fogging” the memory to block the trauma.
This unpeeling of my psychological repressions takes place while the shoppers grab her for advice and information.
“Can you have a look for her, Peter,” she says. It’s the brusque tone of a woman working the natural therapy version of an ED.
During my diagnostic report her voice drops to a whisper only once — after she raised the possibility of future prostate problems, she softly utters the words, “you may also get sexual problems” — looking up to check no one is in earshot.
In the store, customers walk around clutching small bits of folded paper. On these folded slips are names of various pills and potions. These are ‘prescriptions’ written by the shop’s naturopaths who discuss ailments and suggest treatment options. They offer explanations of the body’s working, suffused with the language of folk biology.
“It helps strengthen the lymphatic system, so you won’t get that mucus.”
An elderly woman in her late 60s, following a quickie iridology assessment in front of the cash register, brings out her purse. Four bottles are scanned in.
“One-twenty, 45, thanks.” She hands over cash and a credit card and then rummages in her purse for a store loyalty card. One-twenty, 45 — $120.45.
My prescription is a fraction of that cost. Lou suggests 5 HTP — described on the pack as a “neurotransmitter support” — which I am to take orally. The packet says it “supports positive mood”, with a small asterisk pointing to a FDA disclaimer.
Then there’s St John’s wort and the vitamin industry’s pill du jour, magnesium chelate. The bill is just $49 but I didn’t take up Lou’s suggestion for a probiotic, amino acid or enzymes. She doesn’t mind. There is no pressure, even though she’s spent 15-20 minutes with me — including the free iridology.
Time and money
A couple of hours later, I’m on the phone to a man whom I’ll call Mr Dodder.
I’ve been told he charges $100 for a consultation and I’m slightly shocked that he rates his skill so highly. I phone to check.
“One-hundred dollars should be the fee,” he says brightly. “But it’s $70. That is a ridiculous amount. It’s a last-century price.”
Mr Dodder’s name is followed by ND, D Nut and many other acronyms I don’t recognise.
He is keen to prove he’s value for money when I mention my ailment.
“It will take the full hour,” he reassures me.
The address he gives leads to a lift at the back end of a shopping complex. The lift doors slide open and I walk along corridors past a line of fibro offices to the clinic.
The waiting room is empty. There’s a card on the reception desk listing the clinic’s therapeutic modalities — reiki, homeopathic medicine, naturopathic medicine, lymphatic drainage massage and Feldenkrais. But there is no Mr Dodder.
I ring the bell and it’s five minutes before he appears from behind a door.
“Paul? I’ll be with you soon.” He’s a fit-looking, middle-aged man. He’s dressed smartly — shirt, tie, slacks and trainers.
I’ve not been sleeping well, I tell him. I don’t know much about naturopathy but I’m willing to give it a go. I tell him I don’t feel that the problem is so great I need a doctor to prescribe sleeping tablets.
“You are referring to allopathic techniques?”
“Sorry, what?”
“Allopathy.” Then he writes the words on the paper in front of me and circles them for emphasis: “allopathy”, “homeopathy”, “naturopathy”.
“Allopathy is what is considered mainstream medicine. It means ‘against the body’. That’s what it is. You know, ANTIbiotics, ANTIdepressants. Homeopathy, on the other hand, is ‘with the body’, not against it.”
Mr Dodder goes on to explain his approach. Again on the paper he draws: a triangle for “underlying cause” and a circle on top of the triangle to represent “symptoms”. The principle, he says, is to deal with the “underlying cause”, not just the circle.
“It’s not about this,” he says, stabbing a finger at the circle. “You understand?”
I’m not sure how this differs from the practice of every doctor in the country, but he warns that his techniques will require some time. I have to provide him with enough information on possible underlying causes to fill the five blank pages of A4 paper lying on the table. It’s on this basis that he will be able to offer therapeutic suggestions.
“It could be your bed, it could be your pillow.” So we discuss pillow thickness. I say I think it’s average.
“There’s no such thing as average,” he declares.
He walks over to his consultation couch and picks up a pillow. He looks at me with the smile of a man who’s about to prove his point, Sherlock Holmes-style. I take the pillow and squeeze.
“Mine is slighter thicker,” I admit.
We discuss whether I sleep on my back or on my side and which side, and whether I know which side I sleep on at the point of going to sleep. He wants me to find out.
We discuss what I think about when I go to sleep. Normal stuff, I say.
We go on to explore changes in my life over the past nine months that may have triggered the change in my sleeping patterns. My work, my family. We discuss my elderly parents and my fears about them dying and he writes this in his notes.
At one point he lifts the sheets of paper to show how much we’ve learnt about potential underlying causes through the holistic approach. He looks pleased.
Halfway through, the phone on his desk rings.
“I’m going to change my voice. It’s from overseas.” Unsure why he’s going to change his voice, I figure it’s a professional consultation with a patient so try to look away.
“Yes ... Yes ... Yes…”
After a minute of silence he finally says: “Will you remove my number from your directory … Will you remove my number from your directory ...WILL-YOU-REMOVE-MY-NUMBER-FROM-YOUR-DIRECTORY!”
Then, using two hands, he gently replaces the phone back on the hook.
“Sorry about that.”
“An Indian call centre?”
He ignores me.
At various points during the consultation, Mr Dodder stresses his reluctance to prescribe his treatments, which are apparently compounded by a local pharmacist and sold by Mr Dodder for $15 a pop.
“Look, I’m not going to do what mainstream doctors do — take a drug off the shelf, give it to the patient, take another drug off the shelf give it to the patient."
Holistic natural therapy is about tailoring specific treatment to the specific needs of the specific individual, he says. But progress is slow.
About 50 minutes in, with the outside darkness closing around us, he says we haven’t got to the underlying cause. “I don’t feel there is anything I can do based on what we’ve got here.”
Conscious that time is getting on and that I’ve got to come up with more possible underlying causes to fill the five pages, I get a feeling in my stomach. It’s the desperate feeling of a small boy kept behind after school until he names names.
I mention a relaxation technique I use — controlled breathing when sleep won’t come. He asks what I’m doing, and when I describe it he tells me the technique is wrong.
“You don’t breathe in through your mouth, never breath through your mouth. People do it all the time and then we wonder why we’ve got such high rates of asthma in this country.” Mr Dodder shakes his head in disbelief.
Breathing in through the nose, he says, is much better because it humidifies the air, allowing the nose to cleanse the air before it goes into the body, thereby preventing infection and mucus.
He instructs me on a four-part breathing exercise that will “reduce the carbon dioxide in my brain”. It involves inflating the abdomen and then lungs, and then deflating the lungs and then the abdomen.
“Can you feel it here,” he asks, pointing at his forehead. “I feel more relaxed already,” he says, with genuine pleasure. The tension finally eases for me too.
I ask how he decides which techniques to use, given his skills in so many areas of alternative therapies.
“You know, how do you decide whether you are going to use crystals or some other tech…”
“Crystals!” He stares hard at me. “We don’t do anything with crystals or aromas or anything like that. We are traditional therapists trained in traditional techniques.”
At end of the consultation, I pay the money ($70) and he picks up a digital clock from his desk showing it’s 6.20pm. It’s been over an hour.
“I’m not charging you for an extended consultation,” looking very pleased with himself. Future consults are $80, with a $40 fee for any cancellation with less than 24-hour notice. He only takes cash or cheque.
That night in bed I stare into the darkness, worried that I have given a strange man I’ve never met before my family address and phone number. I don’t sleep.
Confessions
Alongside the climate change sceptics, the faith healers, the antivaccine campaigners and the intelligent design defenders there sits another abuser of evidence-based practice — newspaper feature writers, believers in the power of n=1 narratives to give meaning to the statistically meaningless.
It’s no different here, I confess. My biggest worry before I left the office for my appointments with Lou and Mr Dodder was what I would write if the iridology and naturopathy did actually soothe and heal.
So, I can only plead the subjective “facts” established by this self-interested participant. First, Lou’s diagnostic account flirted with the truth before plunging off in some Freudian psychobabble about in utero imprints.
The “pancreatic bulge” — that was close to the established truth. I thought for a moment she was going to diagnose from my “anxiety depressive iris type” the type one diabetes I’ve had since 1991.
Insulin regulation is an issue, she said, and she was right — although whether her belief that the morning Weetbix was leading to a cycle of hypoglycaemia could be disputed. And the pills she prescribed, especially the St John’s wort: there is evidence that they work in the treatment of depression.
With Mr Dodder, the therapeutic relationship was fraught almost from the beginning. Perhaps we clashed because I struggled to believe in him. I guess that happens to a lot of health practitioners. He didn’t take a proper history, despite his commitment to holistic treatment. But to be honest, I was relieved. I wanted out of the room.
However, Mr Dodder was true to his word. He didn’t prescribe any “medication”. And the breathing technique was relaxing, even if it didn’t succeed in making the $70 fee seem good value.
I must also add that he was strictly kosher when I told him about my diabetes. Insulin therapy didn’t offend his homeopathic principles. He left it alone.
Among the undecided
Across Sydney is the Newtown Community Chiropractic clinic, the last stop on this brief tour of the alternative medicine world.
I’m there on a wet and humid Saturday afternoon to listen to a talk by a bearded, but clean-cut, man in his late 30s called Nimrod Weiner. For the next two hours it will be Nimrod’s job to inform us on the safety and efficacy of what is generally regarded as medicine’s greatest gift: vaccines.
In an upstairs room, as the ceiling fans twist slowly above, are 30 or so people whose profile probably fits the current Newtown demographic — young, educated, alternative; the kind who don’t use plastic bags, don’t deny climate change and don’t tune in to Alan Jones. Here, among men wearing Che T-shirts, are mums with bubs swaddled to their chests and women at the point of pregnancy where it’s best to offer them a seat.
The woman next to me asks if I’ve got kids, if that’s the reason I’m here. She looks down at her baby bump. “I’ve been procrastinating. I’m undecided. I want to pick and choose. I just don’t want to be a sheep, you know.”
For the next two hours, from the moment Nimrod starts to talk, she takes notes.
Nimrod, a chiropractor whose website says he has a masters in paediatrics, tells us early on this isn’t going to be a rant on an issue that has become politically and emotionally charged. He’s here today, he says, to provide a fearless appraisal of the hard science.
“One of my roles, apart from working in this practice, is that I sit on the board of the Spinal Research Foundation,” he says. “What that means is that every day I am reading a lot of research articles. I’m good at knowing how to read a research article, I know whether it’s viable or not. I’m also good at collecting that research. What that means is that this is right up-to-date.”
As he starts to walk the floor, backed up with his slide presentation, he provides an overview of the immune system, and lists the kinds of things that make up vaccines. He includes emulsified peanut oil, aluminium, thiomersal, formaldehyde and then throws in a line about manufacturers growing the chickenpox virus on aborted foetuses.
He must sound convincing. At least, no one questions him. But the claims — which include “no vaccine study has been done on safety around the world by anyone but the drug companies” — are often stripped of both context and of the qualifiers you hear when academics discuss their work.
Nimrod also talks a lot about “links” and “connections”. I’m figuring that the audience, for all their education, may be missing the subtleties of the language, the statistical distinctions between weak links and strong links, and the distinction between association and causation — the things you learn when you discover the wonders of P values.
For me it all falls apart when he gets to the MMR–autism controversy. The first name he mentions is Wakefield, the UK doctor struck off after his fraudulent 1998 paper helped fuel media panic and a slump in the country’s vaccination rates, resulting in rising measles rates every year since 1998.
Nimrod begins as a paragon of scientific disinterest.
“I want to state there is good evidence and bad evidence on both sides [on the link between MMR and autism]. I want to present the scientifically valid research that is out there on this issue.
“A lot of people have heard about a famous case with a medical doctor in Britain called Dr Wakefield, who published back in the BMJ about a possible link between autism and mercury in MMR and has been deregistered. My feeling is, and I have read the study, is that the study itself is scientifically good.”
There is one bloke in the audience with a bundle of sheets printed off the internet. And he lays down the challenge. First he corrects Nimrod — Wakefield’s research was published in the Lancet not the BMJ.
Then the questioner starts listing studies — negative and positive — drawn up in the aftermath of the saga, as scientists attempted to offer the world a detailed picture of what the science said. “There is a hugely greater number of negative [studies] than positive,” the man says.
Nimrod responds by referring to the “hierarchy of evidence” in peer-reviewed journals.
“But you think the Wakefield research was good?” I ask.
“The Wakefield study showed there was a connection between MMR and autism,” Nimrod says. “Some of his ethics were questioned and a lot of the other co-writers have removed themselves from that study and the BMJ [he means the Lancet] has retracted that study itself.”
He doesn’t tell us that Wakefield’s paper was on just 12 kids, or that it doesn’t actually claim a link between autism and vaccination—Wakefield made that link later when talking to journalists.
He does mention the BMJ editorial this year that made further allegations against Wakefield. But again he does not tell his audience about the editorial’s conclusion: that the “clear evidence of [Wakefield’s] falsification of data should now close the door on this damaging vaccine scare”.
Nor does he relay the fact that the BMJ accused Wakefield of being “so incompetent that he was unable to fairly describe the project, or to report even one of the 12 children’s cases accurately”.
The man falls silent, the printouts only take him so far. Nimrod keeps going, unperturbed. He’s not dogmatic. He wants to convince. And he throws in good advice on breastfeeding and healthy eating and the importance of questioning doctors and not being a sap to their authority just because they want to boss you about.
And Nimrod, it’s important to stress, is rarely directive. The only vaccine he explicitly urges us against is hepatitis B — and vitamin K injections in newborns.
Occasionally someone chips in. One woman talks about the influence of the "trans-global drug company cartel" and then offers an account, spoken in horrified tones, on the risk of cross-species infection involving monkeys.
"I've heard that in certain vaccine there are viruses from monkeys and chickens," she says. "We listened to the Australian Vaccination Network. We asked a question and the lady said 60 different rogue viruses were linked to the chicken pox vaccine."
When Nimrod eventually gets to the herd immunity concept, it turns out he believes it logically flawed.
"It is a theory that really doesn't make sense," he declares. "If I say vaccines are effective and they are able to protect my child, if all of you vaccinate your child and I don't, if my child comes into the surroundings then your child should be protected. Either vaccines protect my child or they don't protect my child. You have to stick with one logical resolution."
Again the man with the printouts -- a sole questioning voice -- fights back: "It's like wearing seatbelts. They can't guarantee I won't die in a car crash. But it reduces my risk. [The virus] can't propagate in the community because there are too many immune people out there."
Nimrod: "But if you come into the contact with the bug, you're going to be exposed to it whether you have been vaccinated or not. People around you who have not been vaccinated or been vaccinated, are not going to protect our body."
The man falls silent - so Nimrod moves on to the idea that some of the infections we vaccinate against are not that bad. Chicken pox "makes you uncomfortable", he says, but it is usually not dangerous and it's better for the body to generate its own immune response naturally.
He's silent on polio and whooping cough and it is notable that his Apple Mac slide show includes no pictures of kids with smallpox.
He ends the talk, referring to the wonders of chiropractic care, the way it uses modern computer technology to identify stresses and offering us discounts on first consultations.
Once it’s over, I go up to him to tell him I’m writing a story and want to use his presentation. I tell him I work for a magazine called Australian Doctor and expect him to start railing against the wrongs of the medical profession in the vaccine saga.
It turns out he claims he’s done five years of a medical degree.
“But why are some chiropractors choosing to inform the public about vaccinations?” I ask.
“What do you think?”
“I don’t know.”
“It’s about people’s health,” he says.
--
Kind regards,
Fran Sheffield
Homeopathy Plus! (Tutorials - Remedies - Immunisation)
http://www.homeopathyplus.com.au
Do No Harm Initiative (Free Information on Homeopathic Immunisation)
http://www.d-n-h.org
Homeopathy for Autism (Guidelines for Treatment - Search for Practitioners)
http://www.homeopathy4autism.com