NIVFO-Bulletin - 1989 No 2

Magazine Overview

This issue of NIVFO bulletin, volume 9, number 2-89, published by NORSK INSTITUTT FOR VITENSKAPELIG FORSKNING OG OPPLYSNING (NIVFO), is a Norwegian publication focused on scientific research and enlightenment. The cover headline, "Sjarlataner kan bevege seg fritt" (Charlatans can move freely), sets a critical tone for the issue, which delves into various aspects of alternative medicine and pseudoscience.

Articles and Content

"Legen og naturlegen" (The Doctor and the Natural Healer) by Lege John Nessa

This article examines alternative medicine through the lens of communication theory, presenting a clinical example of homeopathic practice. The author is critical of the medical content of homeopathy's diagnoses and treatments, concluding that alternative medical practices should be rejected on theoretical grounds. Nessa argues that while conventional medicine has its limitations, this does not justify the acceptance of unproven alternative methods. He distinguishes between 'illness' (subjective experience) and 'disease' (objective medical condition), noting that patients often seek help for the former. The article also touches upon the role of media and advertising in promoting questionable health products and services.

"Alternativ" medisin ("Alternative" Medicine) by Lege John Nessa

This piece further explores the concept of "alternaiv" medicine, using communication theory to analyze the relationship between school medicine and alternative practices. Nessa defines alternative medicine as treatments not recognized by medical faculties, including herbalism, homeopathy, and iridology. He uses a case study of a patient with vague symptoms who was diagnosed by a homeopath with 'dirty kidneys' and advised to drink a special tea. While the homeopathic diagnosis was medically unfounded and costly, the patient felt relieved and impressed by the homeopath's attention. Nessa suggests that the success of alternative medicine lies in its communicative content rather than its medical efficacy, providing emotional support and a sense of agency to patients.

"Lege-Pasient-Kommunikasjonen" (Doctor-Patient Communication)

This section, also by Kjell Aass, discusses the importance of effective communication in the doctor-patient relationship. Aass advocates for a 'health business model' where patients are seen as customers, emphasizing productivity and customer satisfaction. He highlights that patients often have a subjective experience of their problems ('illness') and that doctors must acknowledge this perspective. The article stresses that while patients may be right in their subjective experience, doctors have a professional and ethical duty to provide evidence-based care and avoid misleading patients. The author contrasts the digital (verbal) and analog (non-verbal) aspects of communication, noting that alternative practitioners often excel in the latter.

"Kiropraktikk" (Chiropractic)

This article critically examines chiropractic, labeling it as the most prominent of non-scientific healing methods. It notes that chiropractic has achieved a high level of organization and recognition in many countries, posing a social problem rather than just a competitor to regular healthcare. The article traces the origins of chiropractic to Daniel D. Palmer in the late 19th century, who developed a theory based on 'subluxations' in the spine affecting 'nerve current.' The author states that no chiropractor has ever demonstrated the existence or significance of these 'subluxations' for health and disease. While acknowledging that spinal manipulation itself is used by other professionals like physiotherapists, the article asserts that chiropractic's theoretical foundation is unscientific.

"New Age - Big Business"

This section reports on the growth of the New Age movement in Norway, transforming from a marginal interest for idealists into a significant commercial enterprise. In 1987, New Age businesses had a turnover of over 400 million kroner, with 'natural foods' and 'alternative medicine' forming the largest share. The article points to the rise of courses, books, and magazines promoting New Age ideologies. It also notes an increase in the sales of 'herbal remedies' and a significant rise in the number of practitioners for various alternative therapies like zone therapy, acupuncture, and homeopathy. The piece suggests that the New Age market may also attract individuals seeking alternative paths during economic downturns, potentially leading to 'corporate shamans.'

"temanummer"

The issue includes a section titled "temanummer" (thematic issue) which features a byline for H. Thomas Ballantine, Jr., M.D. Clinical Professor of Surgery Emeritus at Harvard Medical School. This suggests a contribution from a medical professional offering a perspective on the topics discussed.

Recurring Themes and Editorial Stance

The recurring themes in this issue are the critical examination of alternative medicine, pseudoscience, and the New Age movement. The editorial stance is clearly skeptical, emphasizing the importance of evidence-based medicine, scientific reasoning, and critical thinking. The publication aims to expose the lack of scientific validity in many alternative practices and warn the public against deceptive claims. There is a strong focus on the distinction between genuine medical science and unproven or pseudoscientific methods, with an underlying concern for patient welfare and informed decision-making. The issue also highlights the role of communication in healthcare and the potential for exploitation within the alternative health market.

Title: Nordisk Medicin
Issue: 11
Volume: 102
Date: 1987
Publisher: Nordisk Medicin
Country: Norway
Language: Norwegian
Cover Headline: Skolemedisinen som grobunn for den alternative medisin (Conventional medicine as a hotbed for alternative medicine)

This issue of Nordisk Medicin delves into the critical examination of chiropractic theory and practice, contrasting it with conventional medicine and exploring the rise of alternative health approaches. The articles question the scientific basis of chiropractic, particularly its central tenet of 'subluxation,' and highlight the inconsistencies and lack of empirical evidence supporting its claims. It also addresses the broader landscape of alternative medicine, including acupuncture, and raises concerns about quackery and the need for consumer protection.

Chiropractic: A Critique of Theory and Practice

The issue opens with a strong critique of chiropractic theory, citing a 1963 report from the College of Physicians and Surgeons of Quebec that questioned its scientific validity. Professor Edmund Crelin's work is mentioned, demonstrating that 'subluxations' significant enough to affect nerves were impossible to induce without total incapacitation. The article criticizes the chiropractic profession's response to such challenges, often resorting to dismissals rather than scientific engagement.

It is noted that chiropractors have historically used the argument of insufficient government funding for research as an excuse for the lack of scientific backing for their theories. However, this claim was challenged in 1972 when the International Chiropractors Association (ICA) reported federal funding for research into methods of measuring spinal alignment, aimed at establishing the existence of chiropractic subluxations. Despite this, the research by Dr. Suh at the University of Colorado reportedly yielded no conclusive results, and Scott Haldeman, a third-generation chiropractor, is quoted as criticizing efforts to find 'more accurate ways to measure a subluxation' due to a lack of solid data suggesting their significance.

The concept of 'subluxation' is presented as the theoretical and legal foundation of chiropractic, yet its definition and scientific basis remain elusive. The article points out that while biologists have made significant advances, chiropractors have struggled to define their theory or practice scientifically.

Lack of Clinical Credibility

Investigations into chiropractic practice reveal significant inconsistencies. A 1969 study by Smith, visiting Palmer Clinic and National College Clinic, found differing diagnoses of subluxations at the same spinal levels. Stephen Barrett's 1980 investigation involving a four-year-old girl revealed wildly different diagnoses from five chiropractors, ranging from shoulder blade misalignment to pelvic twists and nerve impingements affecting various organs. Mark L. Brown's five-month investigation for the Quad City Times also uncovered numerous discrepancies, including contradictory diagnoses about leg length.

The article suggests that the inconsistencies in diagnostic findings are a major issue, with chiropractors failing to provide consistent results even for the same patients.

The 'Straight' vs. 'Mixer' Divide

A significant division within chiropractic is identified between 'straights' and 'mixers.' 'Straights' adhere more closely to the original theories, while 'mixers' incorporate a wider range of therapies, often including unproven methods like iridology, applied kinesiology, megavitamins, herbalism, and crystal therapy. The article notes that while 'straights' might be labeled 'cultists,' 'mixers' are equally unscientific due to their eclectic approach.

The US Department of Health and Human Services' Office of Inspector General (OIG) report from 1986 highlighted the ongoing controversy and inconsistencies within the profession regarding chiropractic theory and practice. The OIG report noted patterns of aggressive marketing and practices that could mislead patients.

The Role of Placebo and Psychological Factors

Despite the lack of scientific evidence, chiropractic maintains a loyal following. This is attributed to the somatic relief provided by spinal manipulative therapy (SMT) and the psychological aspects of the treatment. SMT involves hands-on contact, which can have a relaxing effect and enhance suggestibility, thereby increasing the placebo effect. Reformer Samuel Homola is quoted describing how the audible 'clicks' and manipulations can have a significant psychological impact, reassuring patients that their spines are aligned, even if the physical manipulation itself is meaningless.

Homola also warns that this psychological effect can be detrimental to mentally unstable or nervous individuals, potentially maintaining or creating psychological disorders. The article also mentions that chiropractors engage in verbal conditioning, and that manipulation itself can be habit-forming.

Selling Chiropractic and Aggressive Marketing

The issue touches upon the aggressive marketing of chiropractic services. Eric Baizer, a former ACA advertising consultant, describes how ACA promoted chiropractors as primary care providers. He admits to using standardized responses and 'factoids' to counter negative press. The article suggests that seminars are held to train chiropractors in psychological patient manipulation, with some procedures being questionable.

Alternative Therapies: Acupuncture

A significant portion of the magazine is dedicated to an examination of acupuncture. It is described as a 5000-year-old Chinese needle-stick method. While acknowledging that acupuncture can be understood through physiology (nerves and chemicals), the article dismisses mystical explanations like Ying and Yang. Its analgesic effect is compared to that of 10 mg of morphine, providing temporary relief for mild pain. However, it questions the lack of rigorous testing against natural improvement, suggesting that mild conditions might improve on their own regardless of treatment.

The article notes that acupuncture was reintroduced to the West in the 1970s, fueled by a desire for quick cures and a fascination with Oriental mysticism. It suggests that in China, acupuncture might be used as a substitute where access to corrective lenses is limited, implying it's a fallback option rather than a scientifically validated treatment.

In the West, acupuncture is primarily used for symptoms resulting from physiological disturbances, not for irreparable pathological conditions. Despite investigations by Western medical experts, the article claims that healing effects have not been proven in controlled trials. It also raises concerns about the hygiene practices of some acupuncturists, suggesting it could be a transmission vector for diseases like AIDS and hepatitis.

Transcutaneous Nerve Stimulation (TNS)

Transcutaneous Nerve Stimulation (TNS) is presented as a recognized treatment where patients stimulate peripheral nerves using a battery-powered device. This method is believed to block pain signals by releasing the body's natural opiates. The article suggests that the mechanism of acupuncture might be similar to TNS, involving peripheral nerve stimulation.

Risks and Side Effects

The article highlights potential risks associated with alternative therapies. Acupuncture needles have been found lodged in patients, requiring surgical removal. The article quotes a British Medical Association report stating that acupuncture points are located near vital structures, and complications ranging from minor to fatal have been reported. Poor hygiene practices are also cited as a risk factor for transmitting infections.

Calls for Reform and Regulation

Congressman Claude Pepper is featured, advocating for reforms to combat medical quackery. He proposes increased criminal sanctions for fraudulent health claims, better evaluation of medical technologies, and increased funding for research into chronic diseases. He emphasizes the need for a dedicated office to coordinate consumer information on health.

Pepper criticizes the lack of legal recourse for victims of medical fraud, noting that current laws are insufficient. He suggests raising penalties for mail fraud related to medical quackery and ensuring that victims are compensated for their losses.

The Situation in Norway

The article then turns to the situation in Norway, noting the increasing criticism of conventional medicine and the growing interest in alternative health forms. It attributes this trend partly to patients' unmet expectations from conventional medicine and partly to the perceived inadequate forms of conventional healthcare delivery.

Patients interviewed expressed dissatisfaction with conventional medicine's inability to cure them, its failure to help with chronic conditions, and the fear of medication side effects. They often found alternative practitioners more attentive, willing to spend more time, and more empathetic. The perceived naturalness and lack of side effects of alternative remedies were also appealing.

The article criticizes the 'arrogant' and 'offensive' nature of some conventional medical interactions, contrasting it with the more dialogical and holistic approach of alternative practitioners. It suggests that alternative medicine practitioners are often seen as idealists, even persecuted, aligning themselves with patients.

Critiques of Specific Alternative Therapies

Beyond chiropractic and acupuncture, the article touches upon other alternative practices. It mentions homeopathy, iridology, and applied kinesiology as examples of unproven methods. The article references a report from the British Medical Association (July 1983) that questions the scientific basis of alternative medicine, noting that while conventional medicine has advanced significantly, alternative therapies often lack empirical support.

Consumer Protection and Skepticism

The issue strongly advocates for consumer protection and skepticism towards unsubstantiated health claims. It highlights the role of organizations like The Skeptical Inquirer in promoting critical thinking about health claims. The article references a Consumer Reports article from January 1987 that critically examines homeopathic preparations, deeming them too diluted to have a physiological effect and potentially dangerous when used for serious conditions.

Conclusion and Editorial Stance

The overall stance of the magazine is highly critical of chiropractic and many forms of alternative medicine, viewing them as pseudoscientific, lacking empirical evidence, and potentially harmful. It advocates for a science-based approach to healthcare, emphasizing the need for rigorous testing, transparency, and robust regulation to protect consumers from medical fraud and ineffective treatments. The magazine promotes skepticism as a vital tool for navigating the complex landscape of health claims and encourages a demand for scientifically validated treatments.

Recurring Themes and Editorial Stance

The recurring themes in this issue are the critique of chiropractic theory and practice, the examination of alternative medicine (particularly acupuncture), the prevalence and dangers of medical quackery, and the importance of scientific evidence and consumer protection in healthcare. The editorial stance is clearly skeptical of unsubstantiated health claims and strongly advocates for evidence-based medicine, highlighting the potential for harm and deception in pseudoscientific practices. The magazine aims to inform the public about the limitations of both conventional and alternative medicine when not grounded in scientific validity.

This issue of a Norwegian publication, likely focused on skepticism and critical analysis of health claims, delves into the complex landscape of alternative medicine and quackery, primarily within the Norwegian context during the 1980s. The content critically examines the rise of alternative practices, their perceived effectiveness, and the regulatory and ethical challenges they present.

Alternative Medicine vs. School Medicine

The opening articles explore the societal perception and status of alternative medicine. It's noted that alternative medicine often appeals to individuals with lower social status, allowing for more open feedback from patients. As alternative medicine gains status, there's a question of whether its practitioners' demeanor and patient interactions will change. The text draws a parallel between the 'feminine culture' often associated with alternative medicine and the 'masculine culture' of school medicine, noting that women traditionally dominate alternative practices while men dominate school medicine. A 1982 survey of female doctors in Norway indicated a desire to incorporate more sensitivity, care, and 'soft values' into medicine, elements that patients often report missing in school medicine. The author expresses doubt about school medicine's ability to fundamentally change but suggests it might adopt elements of alternative practices, similar to acupuncture. A concern is raised that if school medicine doesn't adapt, it risks becoming like King Midas' touch, turning everything into 'school medicine' without genuine transformation.

Many patients use both school and alternative medicine, typically consulting school doctors first. However, if school medicine fails to provide adequate help or validation, patients may turn to alternative practitioners. The issue posits that school medicine, as it currently stands, provides fertile ground for the growth of alternative medicine.

Commentary and Letters

Subsequent sections include commentary and letters from readers. One letter discusses a news report about public trust in alternative medicine, citing a study by Vigdis Christie. The letter questions the methodology and conclusions of the study, particularly regarding patient diagnoses and the certainty of those diagnoses. It also touches upon the potential for misrepresentation in media coverage.

Another section references an article from 'The Skeptical Inquirer' on the psychopathology of quackery, posing questions about how and why it works and why people believe in it. The magazine promises further discussion on this topic.

Chiropractic in Norway

A section titled 'Chiropractic in Norway' details the educational requirements for chiropractors, including a four-year study program abroad and a one-year internship in Norway. It mentions that the Norwegian government was considering authorization for chiropractors, with a proposal to maintain the principle that referrals from doctors are necessary for reimbursement from the national health insurance. The article notes that there are 120 chiropractors in Norway, organized under the Norwegian Chiropractic Association. It also includes a news excerpt about politicians, including former Prime Minister Gro Harlem Brundtland, seeking chiropractic treatment for back problems.

Advertising Ban and Quackery Laws

An article by Rolf Manne, a professor of theoretical chemistry, discusses the advertising ban on products with alleged medical effects that are not sold as pharmaceuticals. He explains that while products sold through mail order or in general stores cannot make claims about preventing or healing diseases, pharmaceuticals have stricter advertising regulations. The article highlights the difficulty in distinguishing between legitimate health products and those making unsubstantiated claims. It also references the 'Kvaksalverloven' (Quackery Act) of 1936, which regulates medical treatment by non-doctors. The author points out that enforcement of these regulations is often weak, relying on public reporting of violations to the Directorate of Health.

The Dangers of Quackery

Another article elaborates on the definition and dangers of quackery. It defines quackery as a person who falsely claims medical expertise and promises healing effects without scientific basis. The article explains why quackery can appear to work, citing patient belief, the practitioner's personality, and spontaneous remission. It warns against the financial and health risks, including delayed diagnosis, ineffective treatment, and the promotion of harmful substances. The article notes that the alternative medicine industry is a multi-million dollar business, with significant lobbying efforts.

Specific Cases and Concerns

Several specific cases and concerns are highlighted:

• Selenium Supplements: An article discusses the marketing of 'Bio-selen' in Denmark, which was promoted as a cure for cancer and a solution for selenium deficiency. The article criticizes the marketing campaign, the controversial nature of the experts involved, and the fact that excessive selenium can be toxic. It notes that the Danish National Food Agency warned that selenium in large doses is a poison.
• Homeopathy: A letter to the Canadian Pharmaceutical Association criticizes the inclusion of homeopathic remedies in a pharmaceutical reference book, arguing that homeopathy lacks scientific evidence and that its principles (e.g., 'the less the dose, the greater the effect') contradict established pharmacology. The publisher acknowledged the feedback and stated they would review their presentation methods.
• HIV and Prayer: A news report details a case where an HIV-positive man believed he was cured through prayer, subsequently married and had children, only to die of AIDS. This case is presented as an example of the dangers of religious sects offering unproven 'cures' for serious illnesses.

FAQ Section

The issue includes a FAQ section addressing common questions about quackery, its perceived effectiveness, its dangers, and the regulatory framework in Norway. It clarifies the definition of quackery, explains the placebo effect, and outlines the risks associated with unproven treatments.

Recurring Themes and Editorial Stance

The recurring themes throughout this issue are skepticism towards unsubstantiated health claims, the critical examination of alternative medicine practices, and the importance of scientific evidence and regulation in healthcare. The editorial stance is clearly in favor of evidence-based medicine and consumer protection, highlighting the potential harms of quackery and misleading health advertising. The publication appears to serve as a platform for disseminating information that challenges pseudoscientific claims and promotes critical thinking about health and medical treatments.