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Many authorities in medicine admit that most of the drug therapies

for asthma are making the problem worse.

A medical wh e eze
ne of the biggest medical fail - crease may be due to changes in di- death has ever been caused by un-

O ures of recent years is treat -

ment for asthma. Despite
greater diagnostic skills, better iden -
agnostic labelling—that is, more
wheezing identified as asthma—and
heightened awareness by GPs of res-
complicated asthma [ie, asthma
without emphysema]." The rise of
asthma corresponds to an epidemic
tification of causes of the disease and piratory symptoms.) But other en- of all forms of atopic (hypersensitiv-
ever whizzier drug cocktails to treat quiries suggest the real percentage ity) disease, including hay fever and
it, doctors and asthma associations increase may be higher; the UK eczema.
are stymied by the fact that the epi - asthma taskforce disclosed that Why is this happening in such
demic incidence of asthma and treatment for asthma has doubled in epidemic proportions? No one
asthma-related deaths are continu - the past 10 years. During that time, doubts that the hypersensitivity
ing to go up. Indeed, many authori - hospital admissions have trebled for causing the muscles of the little
ties in medicine admit the cure is all victims and risen fivefold among bronchioles to constrict (and the
infinitely worse than the disease and young children. In Britain alone, the tubes to become inflamed and filled
that the drugs developed to alleviate number of deaths rose to 2000 in with mucus) has to do with allergies.
symptoms of asthma are mainly be - The conventional view maintains
hind the sharp rise in deaths. that the main culprits are grass
Things have reached such crisis
proportions that last April a UK task
‘The drugs pollen or the house dust mite Der -
matophagodies pteronyssinus. This
force on asthma was set up by the Na -
tional Asthma Campaign to investi - used to treat little creature is much more preva-
lent in homes today because of fitted
gate why deaths are going up and
how safe or appropriate the drugs are
asthma carpets, heat and insulation, accord-
ing to Sporik et al, writing in the
for relief of the problem. A similar
study is also being conducted with
could be New England Journal of Medicine in
1990. It is also believed to be genetic.
participating medical centres from behind the One-third of patients have a relative
New Zealand, Germany, Britain and who has suffered from asthma, ac-
America. Here is the latest about the sharp rise in cording to Dr Ruth Lever in A Guide
dangers of conventional treatments
and a variety of alternatives for con - deaths or near to Common Illness (Penguin 1990).
In people prone to asthma, the low
trolling your symptoms without
deaths. . .’ ozone levels of urban environments
can make things worse, according to
As with most allergies, cases of 1988 and has only fallen slightly a Canadian study in the Lancet (27
asthma are sharply on the rise. since. This compares to a death rate July 1991). A recent study from
In a recent study of children in Ab- of virtually zero before the 1950s. France also showed that bron-
erdeen, cases diagnosed as asthma Allergist Dr David Freed quotes a chospasm can be triggered by com-
had more than doubled over a simi- 1929 medical textbook (J J Cony- mercial polyurethane foam for
lar survey in the same area con- bears' A Textbook of Medicine, pub- insulating homes. But house dust
ducted 25 years ago. (The lished by Livingstone in Edinburgh) mites seem to be a very small part of
researchers said that part of the in- as saying, "It is doubtful whether the story (see box, p 3 for other


Special Report: Asthma: how drugs
What Doctors Read: Cataracts and
Books: Inequalities in Health and
often make the problem worse. vitamin C; fluoride and hip fractures. Which? Medicine.

4 6 8
Updates: MMR vaccine withdrawn; Q&A: The new "improved" hepatitis Second Opinion: Harald Gaier.
The trouble with "scientific" tests.
What Doctors Don't Tell You, 4 Wallace Road, London N1 2PG. Editor Lynne McTaggart Editor's PA Jan Green Contributing Editor Fiona Bawdon
Editorial Assistants Dorothy Rothermel, Kerry Johnsonl Designer Clerkenwell Design Group Printed by Premier Press Publisher The Wallace Press
Copyright The Wallace Press No part of this publication may be reproduced without permission.
prevalent causes). names Ventolin ,Ventodisks or Salbu- breath in, and utilize more drug than
The root of the allergy could be a lin), fenoterol (Berotec) and terbu- the usual pressurized aerosol car-
slight malfunction in the immune taline (Bricanyl). tridges. Another possibility is the use
system, having to do with essential If inhaled beta2-agonists don't do the of a spacer, which offers a "space" be-
fatty acids (EFAs). American immu- job or you find you're using them more tween the inhaler and the mouth to al-
nologist and WDDTY panel member than three times a week, the doctor low more time for the propellant
Leo Galland, who has performed a moves up to step two, which includes chemical to evaporate before the drug
good deal of groundbreaking work in anti-inflammatories. Children are reaches you. There are also nebulizers
this field, cites several studies in Su - usually started on a six-to-eight week which produce a spray, slowly releas-
perimmunity for Kids (Bloomsbury trials of sodium cromoglycate (Intal) ing the drug into the bronchial tubes.
£9.99) showing that children with three or four times a day. This drug, If this still doesn't control your
asthma have difficulty converting called a mast cell stabilizer, works by asthma or you have persistent symp-
EFAs into prostaglandins—which reg- preventing the mast cells lining the toms at night despite all the other in-
ulate the function of the immune sys- bronchial tubes from releasing chemi- haled therapies, the BTS suggests
tem. Prostaglandins are controlled by cals causing the bronchial muscles to that you move on to step four, increas-
enzymes; a vital one in converting contract. It is effective in preventing ing the daily dose of inhaled steroids
omega-6 EFAs into an intermediate an attack from starting, but cannot and using an additional bronchodila-
stage from which they go on to become treat an attack once it has begun. tor such as theophylline or amino-
prostaglandins is D-6-D, or what Gal- A similar but more potent drug is phylline on top of the other
land calls the Delta Force. Galland deocromil (Tilade). medication. Theophylline belongs to a
has found that in children and adults Most adults (and children who drug category called the xanthines,
with allergic asthma (as well as haven't been helped by the sodium cro- which includes caffeine. Theophylline
eczema and hay fever) the Delta Force moglycate trial) are placed on inhaled works by relaxing the bronchial mus-
is much less active than normal. "As a steroids, which are supposed to reduce cles and also breaking down a chemi-
result," he writes, "prostaglandin pro- the daily dose and hence the general cal that controls the muscles in the
duction is short-circuited." risks of corticosteroids. These drugs bronchial tubes. Another possibility is
Drug treatment for asthma is include beclomethasone (Becotide) to take oral beta2-agonists, which re-
given largely on a suck-it-and-see and budesonide (Pulmicort). This lease more drug into the body, or a
(or more properly, an inhale-it- anti-inflammatory drug is used con- non-selective adrenoreceptor stimu-
and-see) basis, ending up with the currently with a beta2-agonist inhaled lant like ipratropium bromide, which
patient taking a medicine chest of up to four times a day. affects your heart as well as your
potentially lethal drugs. Recently Step three employs the same bronchial muscles.
the British Thoracic Society published steroids but a more powerful inhaler. If all else fails, you are put on a
new guidelines for following a "step" Dry powder inhalers have cartridges course of oral steroids, in addition to
approach, only graduating on to the which blast the powder when you the other drugs in step four. You
next step in terms of potency of drugs
if the step before hasn't helped. It also
advises that when control is estab-
lished with one step, to consider mov- Asthma treatment
without drugs
ing down to the step below.
Step one begins with short-acting in-
haled beta2-agonists for patients who
experience symptoms infrequently or If you are alarmed by medicine's hit-and-miss approach to asthma with dangerous drugs,
with only mild exercise-induced there are many sensible approaches that may lessen or even eliminate your symptoms. As
asthma. These adrenoreceptor stimu- Leo Galland writes: "If an effective allergy-desensitization technique is used and as much en-
lants cause the nervous system to act vironmental control as possible is exercised, drug-free treatment is virtually always possible
on adrenaline receptors throughout in children."
the body. But unless the drugs are Find an experienced clinical ecologist or allergist who can find out what you are allergic to.
highly selective, aiming only to stimu- This may mean going to someone who is familiar with exclusion diets or, in the case of air-
late "beta2" receptors (which relax borne triggers, EPD desensitization methods which will locate your allergies with far more
bronchial muscles and reduce the accuracy than the old prick-test method .
chemicals causing inflammation) they ●Avoid any food or ingested allergens. That particularly includes milk products. Use a cal-
can cause the heart to race and force it cium supplement if you don't add enough calcium from other sources.
to produce larger quantities of blood, ●Add the following supplements to your daily diet: vitamin B6 50-100 mg, linseed (1-2 Tbs
thus raising the blood pressure. In per day) or walnut oil (2 to 4 Tbs) plus evening primrose oil (4-8 capsules); vitamin C (at least
the past, doctors made use of non-se- 500 mg );' zinc (10-20 mg ); vitamin E (at least 600 IUs); and magnesium.
lective adrenoreceptor stimulants like ●Follow a diet low in sugar, animal fat and additives, and high in grains and vegetables.
adrenaline or isoprenaline, which ●Take regular gentle aerobic exercise like swimming or walking, which reduces symptoms.
work on the heart muscles. But other Dr Galland recommends that asthmatic children have the following supplements, which
than for life-and-death emergencies, play a role in assisting or curing asthma:
it's now agreed that drugs like High doses of essential fatty acids. (I Tbs of linseed oil and 1 Tbs of cod-liver oil or 3 g of
adrenaline shouldn't be used since MAX EPA per day). Magnesium: 3mg per pound of body weight per day. Calcium: 600 mg
they can induce a heart attack. per day if dairy products are eliminated. High doses of vitamin C (2 gms a day). B6: at least
The selective beta2-agonists of drugs 200 mg a day. B12: 1 mg twice a day for six weeks.
are sold in the UK as salbutamol, or
albuterol in the States (with brand

2 WDDTY Vol.3 No.8

might even be given a trial of cy- symptoms improve once doses of in- glands. This dosage also produced sig-
closporin, originally developed to pre- haled beta2-agonists are reduced. nificant growth retardation in a group
vent the body's rejection of organ The new long-lasting and high po- of children studied.
transplants and now medicine's drug tency beta2-agonists like salmeterol Inhaled steroids have also caused
of the month, investigated for every- (Serevent), soon to be available for symptoms characteristic of Cushing's
thing from psoriasis to arthritis. children, which control asthma symp- syndrome: obesity, moon face, thin-
Beta2-agonists have been associ - toms for 12 hours at a puff, could exac- ning skin and stretch marks, as well
ated with an increased risk of erbate the problem. as bruising.
death or near death. According to Steroids used for asthma control Another unforeseen risk is that
the Adverse Drug Reaction Bulletin pose many more risks than previ - many otherwise benign infections be-
(June 1992), which devoted an entire ously thought. Many doctors are come life-threatening in children on
issue to asthma, the marked rise in turning to steroids as a first port of drugs like steroids, which suppress
asthma deaths during the 1960s in call after all the recent bad press for the immune system. America's Food
many countries "coincided with the in- and Drug Administration has asked
troduction of high strength isopre- manufacturers of all steroids to add
naline inhalers". When the inhalers Beyond the following warning on all drug
were withdrawn, mortality fell to pre-
vious levels. But the problems haven't dust mites packs: "Children who are on immuno-
suppressant drugs are more suscepti-
just been due to non-selective beta2- ble to infections than healthy children.
agonists. In many countries, a re- In Food Allergy and Intolerance Chickenpox and measles, for example,
newed rise in asthma deaths occurred (Bloomsbury1989), Jonathan Brostoff can have a more serious or even fatal
in the 1980s, particularly in New says that you should look to many other course in children on immunosuppres-
Zealand, which one study showed was causes besides dust and mites. These in- sant corticosteroids. " Besides the dis-
linked to the popularity of fenoterol, clude infections (as many as 40 per cent ease itself, the risks of vaccination
but also theopylline and oral steroids. of cases can be caused by them); indeed, multiply (particularly with one em-
Another study of beta2-agonists con- many children can be allergic to the ploying a live virus) if a child's im-
ducted by a variety of medical schools viruses, as well as infected by them. mune system has been suppressed.
in America and Canada, including (Pattemore et al in Clinical Exper Allergy As for adults, some studies have
Montreal General Hospital and Yale 1992: 22:325-336). Another aggravating shown that even low doses of inhaled
University (New England Journal of factor is too much salt in the diet and beclomethasone (400 ug) per day) re-
Medicine, 20 February 1992) showed monosodium glutamate, mainly found in duce bone formation (The Lancet 6
that the use of beta-agonists adminis- tinned and packet soups, Chinese food July 1991). Deaths from lack of
tered by a metered-dose inhaler, and other convenience foods. A New adrenal gland function have occurred
specifically albuterol (salbutamol) and England Journal of Medicine study (April when patients have switched from
fenoterol, was associated with an in- 25 1991) demonstrated that parental oral to inhaled steroids without over-
creased risk of death or near death. smoking can contribute to elevated lev- lapping the drugs. There is also the
Several other studies have shown els of airway responsiveness (ie, problem of recurrent thrush of the
that regular inhalation of beta2-ago- bronchial constriction) early in life. mouth.
nists cause "hyperresponsiveness"— Don't discount food as a potential trig- Because some of the drug escapes
that is, excessive constriction of the ger. Dr Freed finds that many patients into the blood stream, even when in-
bronchi (Journal of Allergy and Clini- with asthma are intolerant of dairy haled, people on high doses run the
cal Immunology 1985: 76). products. usual risks of steroids. These include
The June issue of the Adverse Drug Indeed, allergy specialist Dr Keith over-activity of the adrenal glands,
Reaction Bulletin postulated that Mumby (see p 7 ) finds that food is often which produces Cushing's disease, a
beta2-agonists could be behind the in- a more potent trigger than are environ- fat abdomen, buffalo hump in the back
crease in deaths by causing fatal mental factors. Chicken and wheat were of the neck, high blood pressure and
abnormal heartbeats, spreading the frontrunners in provoking symp- muscle weakness.
whatever the allergen is to more re- toms in a random sampling of 16 patients Steroids can also cause muscle wast-
mote airways and thus increasing in- in Dr Mumby's practice. ing, hyperglycaemia, water retention,
flammation, or causing the bronchial beta2-agonists. But recent studies skin atrophy, bruising and stretch
muscles to constrict to a fatal degree. have shown that inhaled steroids marks, insomnia, serious mood
Regular use of these drugs also (which were supposed not to pose the changes, symptoms of schizophrenia
causes the disease to worsen. Yet usual risks that swallowed ones do) or manic-depression, possibly cataracts
another study published in the Lancet are not as harmless as medicine previ- or glaucoma, menstrual problems, im-
in 1990 (336:1391:6) showed that pa- ously supposed. The consensus up un- potence, loss of libido or even allergic
tients receiving fenoterol regularly til now has been that beclomethasone shock. More dangerously, prolonged
(that is four times a day) with addi- dipropionate (BDP) of 400-800 ug use of steroids causes the pituitary
tional inhalations as necessary had daily is appropriate for the 3-5 year gland to stop producing ACTH, a hor-
worse outcomes after six months than old age group. However, a group of mone which regulates the adrenal
those given inhaled drugs only as paediatric consultants from various glands, needed by the body during
needed. Regular use of certain beta2- hospitals in Britain wrote to the stress.
agonists also causes a greater decline Lancet (14 December 1991) to point All this in a drug which can only
in lung function than does "on-de- out various studies showing that this suppress inflammation, not cure it, by
mand" use (The British Medical Jour- dose of BDP was the equivalent of 20- constantly masking what is undoubt-
nal, 7 December 1991). And some 40 mg of prenisoline in causing sup- edly a healthy allergic response.
patients have been shown to have pression of the adrenal and pituitary Lynne McTaggart

WDDTY Vol.3 No.8 3


decide just where to draw the skills, and should provide

A DEADLY CASE OF MUMPS line between drugs and foods. education that is pertinent
As most of our British readers have no doubt heard, last The French, for instance, to the trainees. Time should
want anything labelled as a also be set aside for study
month the UK Department of Health announced the hasty drug if the dose exceeds the and for contact and feedback
withdrawal of two brands of the combined measles, mumps required daily intake. Should between trainee and
and rubella (MMR) vaccine. the French win the argu- teacher.
Pharmacies have been told to discontinue Immravax, ment, the British health food Until and unless the
manufactured by Merieux, and Pluserix, manufactured by manufacturers will be the changes are made, training
SmithKline Beecham. All orders for this particular vaccine major losers. Their goods are for doctors and dentists will
sold in greater quantities as remain unsatisfactory and
will be fulfilled by the MMR II, produced by ineffective, the report con-
foods in British shops than al-
Merck Sharp and Dohme and distributed by most anywhere else in the cluded.
Wellcome. EC. Teaching Hospital Doctors
The official line circulated to the press about Ostensibly, the draft direc- and Dentists to Teach: Its
why these drugs were withdrawn, after having tive, which should be pub- Role in Creating A Better
been jabbed into millions of 15-month-olds, is lished early next year, is Learning Environment. (The
merely being drawn up to Standing Committee on
the results of a study showing that the two
help remove barriers to trade Postgraduate Medical Edu -
withdrawn brands have a negligible (1 in in the single European mar- cation, 26 Park Crescent,
11,000 ) risk of causing a "transient" and "mild" kets. London W1N 3PB)
(all DOH words, these) case of meningitis. But it is part of a general
The MMR II, made from a different strain, wave which is already sweep-
supposedly does not pose this risk. ing the US. There, the Food
This news was greeted by a good deal of and Drug Administration is
proposing to reclassify vita-
cheering in the offices of WDDTY, since we
have noisily protested this vaccine as unsafe
min and mineral prepara-
tions as drugs and to restrict
drug dangerous
from our very first issue. the sale of herbs. Only sub- If your doctor is still pre-
Our celebrations were shortlived, however, as we ob- stantiated claims made by al- scribing clofibrate (Atroid)—
served the decidedly docile press coverage of this event. Vir- ternative medicines will be a drug that lowers
permitted. cholesterol —he could be en-
tually every paper and TV station dutifully printed the dangering your life.
Similarly, the EC directive
standard party line about the problem not being very severe may be less innocuous than Most doctors have stopped
and the remaining vaccine being perfectly safe. And not a sin- the bureaucrats maintain. prescribing the drug, follow-
gle reporter stopped to ask : if this vaccine, herded in amid a Already in the wings is a sec- ing a World Health Organi-
blazing publicity campaign four years ago, was so hastily with- ond directive covering herbal zation trial which revealed
drawn, how "mild" and "rare" could this side effect be? extracts, slimming aids, gin- that it increased the mortal-
seng and royal jelly. ity rate among sufferers by
We then observed a curious bit of arithmetic, which hap- 47 per cent.
While the British health
pens whenever medicine needs to justify a bad call: the turn- The tests showed that
food manufacturers are lob-
ing of a benign problem into a life-threatening illness by the bying hard, there could be a while clofibrate reduced the
manipulation of statistics. When I was preparing our first is- more powerful lobby at incidence of non-fatal my-
sue about MMR in 1989, I interviewed Dr Norman Begg, of work—the drug industry. ocardial infarction, it did not
the Public Health Laboratory Service, which recommended And guess who stands to win lower mortality from artery
if the directive is passed? disease; indeed, mortality
the vaccine in Britain. He assured me that mumps is a very
levels rose by 47 per cent,
mild illness in children. Now, however, we hear from Chief and then fell back to normal
Medical Officer Dr Kenneth Calman that mumps leads on to levels once the drug was
meningitis in 1 in 400 cases. withdrawn.
In other words, because mumps is a dangerous illness, tak- Doc teaching While the industry consid-
ers carrying out further
ing the old unsafe vaccine was still better than getting the dis-
ease itself. How long will it be before we start hearing about standards low tests before the drug is with-
drawn, the WHO findings
the latest killer of children: athlete's foot? The quality of the teaching in indicate that drugs compa-
Lynne McTaggart British hospitals has been nies are vigorously market-
criticized in a new report. ing these types of drug
Consultants and registrars before waiting for the results
The argument, already be-
involved in teaching are from controlled trials cur-
ing aired in the US, pivots rarely required to have any
around the reclassification of rently in progress.
formal training and few royal
vitamins, minerals, amino
acids, fish liver oils, yeasts
colleges have plans to assess QUOTE OF THE MONTH
EC: new assault and other nutrients as drugs
the competence of teachers.
This alarming situation is
"I have been in general prac-

on vitamins rather than foods. tice for 30 years. I sit at a slight

set against a major revalua- angle to my desk; the patient
As foods, they are subject to
tion of postgraduate training. sits near me on the same side,
the minimum of restraints. Annual spend is increasing—
The well-publicized assault But as drugs, they will need within touching distance.. . .
by the EC on vitamins and in 1988-9, it was already at In my consultation I use
to be registered and to ac-
nutrients—which could put £96m—and the General Med- touch quite frequently such
quire a product licence before
the smaller manufacturers ical Council is conducting a as holding a hand or putting an
they can be sold. This route is
out of business—is only the review of basic medical edu- arm round a shoulder. . . . And
both costly and time-consum-
first wave of a sustained cam- cation. I have noticed that some pa-
ing, and several industry
paign, we can reveal. The new report, prepared tients touch me. . . .
watchers have said it will be by the Standing Committee
A second European direc- enough to cripple all but the What is being communi-
tive is in the wings which will on Postgraduate Medical Ed- cated? . . . Perhaps it shows
very biggest vitamin manu-
curb the sale of herbal ex- ucation, recommends that that the patient has solved the
tracts, ginseng and royal jelly. trainers should first be problem with the doctor's
However, the EC has yet to
taught effective teaching help–"Let's do this to-
gether."–Alun J B Edwards,
4 WDDTY Vol.3 No.8

that breastfed babies were Cambridge University School

get. Delaying the onset of
frequently given water to of Clinical Medicine.—
Fluoride: hip cataracts by 10 years could
reduce the need for surgery
The survey, conducted by
British Medical Journal, 1
August 1992.
fracture risk by 45 per cent.
It was against this back-
Sally Beeken and Tony Wa-
terston of the Community
drop that the survey was
Fluoride in the water supply Child Health department at
started in 1980 among female
actually increases the risk of Newcastle General Hospital,
hip fracture among the el-
registered nurses over the
age of 45; others were in-
was intended to measure atti-
tudes of professionals to
Hib vaccine:
derly, a seven-year study
among the over-65s of Utah
cluded as they reached that
Most professionals agreed
poor showing
has discovered. During the survey period,
While fluoridized water is that breast milk is better for A major study examining two
493 cataracts were removed.
supposed to help treat osteo- babies than formula milk, versions of the new
Those in the study group who
porosis, the survey confirms but 28 per cent disagreed that haemophilus influenzae b
took regular doses of vitamin
suspicions that it may in fact breastfed babies are health- (Hib) vaccine, introduced this
A had a 39 per cent lower risk
weaken bones. Researchers ier, and nearly half disagreed month in Britain, shows that
of developing cataracts.
had earlier noted increased that milk company advertis- they don't work as well as
Among the food groups, those
hip fracture rates among ing should be banned in ante- they should.
who regularly ate spinach
women who were treated natal clinics. The vaccine, being offered
also seemed to face lower risk
with supplemental fluoride. Although 71 per cent of pro- to infants at two, three and
of developing cataracts, al-
Fluoride apparently causes fessionals agreed that lay or- four months, is supposed to
though no evidence seemed to
new bone formation of an in- ganizations should be protect against Hib-caused
support the remedy of folk-
ferior quality, especially advertised, only 45 per cent meningitis.
lore that carrots could im-
around the femoral neck (the felt they should be allowed However, the study by the
prove the eyes.
hip). While its compressive into hospital to help women National Centers for Disease
The risk was also low
strength increases, the bone's with their breastfeeding. Control in Atlanta, Georgia,
among those who regularly
tensile strength diminishes. This was a surprising re- of 10,400,000 children,
took vitamin C for 10 years or
The study, carried out by sponse, as 35 of the 50 partic- showed that the "polysaccha-
more, although this was not
the Department of Family ipating mothers had ride" version of the vaccine of-
so among those who took vita-
and Preventive Medicine at difficulties with breastfeed- fered protection in 64 per
min C as part of a multivita-
the University of Utah, ing. Twelve had stopped cent of cases and the new
min. The beneficial effects of
wanted to discover if people breastfeeding by three weeks, "conjugate" vaccine, only 74
vitamin C were particularly
exposed to much lower quan- and nine had stopped in the per cent protection.
strong among those who have
tities of fluoride through their first week. The most common Nine of 75 children with
never smoked.
tap water would be similarly reasons were that the baby Hib disease had received the
The study team said their
affected. The water supply in was not getting enough milk; vaccine just two weeks before
findings lend support to the
the area is fluoridized at 1 the mother could not tell how they became ill.––JAMA, 19
antioxidant hypothesis of
ppm. much milk the baby was get- August 1992.
cataract prevention.—British
They were tested against ting; the mother was too ill;
Medical Journal, 8 August SHORT TAKES
two communities with no flu- the baby was ill or rejected
oridization of their water. ● Another study has shown
the milk; and engorgement
and painful nipples. ●For several low back
The team concluded that that smoking cigarettes sub-
fluoride does increase the The study team also points disorders such as herni-
stantially increases the risk ated disks, spinal steno-
risk of hip fracture. They out the ambivalence of the
of developing cataracts in sis, spondylolisthesis
point out that, according to professional toward breast-
later life.—Journal of Ameri- and degenerative disk
other tests, the numbers of feeding. While they seem to
can Medical Association, 25 disease, a study of 47 ar-
hip fractures actually in- agree about the superiority of
August 1992. ticles in the medical lit-
crease in areas where there breast milk, they seem less
are higher levels of fluoride in clear about the reasons. erature could find no
the water.—Journal of Amer- They were also concerned advantage demon-
ican Medical Association, 12 that all is not well with hospi- strated for using spinal
August 1992. Breastfeeding: tal management if so many
mothers found it difficult to
fusion over simple
surgery without fusions
lip service only breastfeed. The high rate of
mothers who stop breastfeed-
(and indeed no truly sci-
entific trials supporting
Despite all the recent find- ing in the early weeks—in the the use of the proce-
ings that underline the bene- survey, 18 per cent had dure). Spinal fusion
Cataracts: eat fits of breast milk, health
professionals seem to be pay-
stopped within the first 10
days—is disturbing, but cor-
was also associated with
frequent complications,
your greens ing little more than lip ser-
vice to breastfeeding.
responds with national
including chronic
pain.—JAMA, 19 August
A survey among midwives The team recommends that 1992.
The risk of cataracts appears and health visitors in New- health professionals are up- ●Vaccination against in-
to diminish among those who castle upon Tyne showed an dated more often, while the fluenza has been associ-
regularly eat spinach and alarming disregard for the involvement of lay groups, ated with false positives
those who have taken vita- needs of both baby and such as the National Child- on tests for HIV, HTLV-1
min C supplements for more mother. birth Trust and La Leche and hepatitic C virus.—
than 10 years. Of the 50 first-time mothers League, should be encour- JAMA 26 August 1992.
These were the main find- who took part in the survey, aged. ●Skin lightening creams
ings of a long-term survey by 30 were separated from their ●These findings have been can permanently dam-
Harvard Medical School babies on the first night, endorsed by a separate and age skin by causing
among 50,000 women across while 28 babies had received earlier study in Fife, Scot- thickening of the colla-
11 states of the US. food or water rather than land. There, just 40 per cent gen layer and patchy
Surgery to remove breast milk. of mothers were still breast- pigmentation.—BMJ, 8
cataracts accounts for 12 per Nearly half the profession- feeding by the tenth day, ac- August 1992.
cent of the US Medicare bud- als in the survey confirmed cording to Sarah Williams of

WDDTY Vol.3 No.6 5


Q I was amazed to read the

inaccurate, outdated and
unnecessarily alarmist ar-
ticle on hepatitis B vacci-
nation by Anthony Morris and Hilary
My daughter, Jennifer, was vaccinated against
measles at the age of approximately one
However, let us call your attention to
several paragraphs toward the end of
the article, which included extracts
from a report prepared by one very
concerned New Zealand doctor about
Butler (WDDTY Vol 3 No 4) year. After the injection she suffered various the effect of the new vaccine on chil -
I am not going to get involved with side effects for a few days (these included a dren. As we reported, the doctor wrote
the pros and cons of mass hepatitis B chesty cough, runny nose and a general "un- that the HB vaccine, given with the
vaccination. Suffice it to say that wellness"). For the following four and a half DPT triple jab and/or the polio vac -
hepatitis B disease can be a lethal years, Jennifer had problems with her left cine, causes a 'significant immune
infection in a small proportion of suf- arm at the site of the injection. There were suppression in a significant number
ferers. Furthermore, those who be- lumps under the skin and obvious discomfort of children, as witnessed by the num -
come chronic carriers (about 10 per and irritation which caused her to scratch the ber of recurrent infections.' The doc -
cent) of the virus have 400 times area continually, often resulting in bleeding. tor also points out that the HB
greater chance of getting liver can- Then about six months ago, the problems vaccine, when given to newborns,
cer than the general population. with the skin at the injection site disap- caused a number of cases of pro -
Some of the contents of the article peared. At the same time, Jennifer started to longed, post-natal jaundice, lasting
would probably have applied to the exhibit symptoms of not being 100 per cent up to two or three weeks. This doctor
vaccines produced in the early 80s. well. She was easily tired, quite lethargic and had never seen either problem in vac -
However, the hepatitis B vaccines subject to quite violent mood swings. She cinated babies before the HB vaccine
that are now being used, especially became more and more uncooperative in was introduced.
those proposed for mass vaccination her general behaviour. She also started to "My biggest reservation with the
of children, are genetically engi- drink a lot of fluids and lose weight. On 10 new HB vaccine is that there's a good
neered. This means that they do not August this year she was diagnosed as dia- deal we don't know about it. Al -
come into contact with human blood betic. I was devastated. There is no history though the American Centers for Dis -
or serums, and therefore there is no of diabetes in our immediate family. I was ease Control recommends that all
possibility of catching HIV or any faced with the prospect of injecting her with newborns get the jab and the UK is be -
other infections from them. The only insulin at least once a day for the rest of her ginning nationwide prenatal screen -
side effects listed are occasional lo- life and the prognosis for the quality of a dia- ing for the disease, top medical
cal redness and swelling, as well as betic'slife is not good. authorities basically admit that we
transient mild fever, headache, joint After the initial shock, I decided not to ac- don't really know whether it is effec -
and muscle pains, nausea and ab- cept the fatalistic attitude of the medical pro- tive, what the side effects are in ba -
dominal pain. Whether or not the fession. I know that Jennifer's condition is a bies and children, or even when the
generalized side effects are related direct result of her measles vaccination. I effect wears off. For instance, the
to the actual vaccine has not yet have started treating her condition in a vari- 1991 edition of The Red Book, pro -
been established.—Dr Kai Kermani, ety of unorthodox ways . She maintains her duced by the American Academy of
Loughton. Essex. normal regime of insulin and diet during my Pediatrics, includes the report of the
treatment. Committee on Infectious Diseases of
I will continue treating Jennifer, reading all the AAP, which says that routine
available data and pestering the hell out of screening of mothers-to-be for HB

As some of you may or may anyone I think might help. I've never even virus is 'recommended,' not manda -
not know, Dr Kermani is studied biology at school—but I've got some- tory—tacit acknowledgement that
one of our panel members, thing that no doctor has got: I love my the jab itself is only necessary for the
who has treated many AIDS daughter. The depth of that love will allow newborns of infected mothers. Else -
patients through a combination of no barriers in my search for a cure. —S.A., where in the volume, the AAP admits
conventional and alternative treat - East Grinstead. that the duration of protection and
ments such as autogenic training. Thank you for your heartfelt letter. We the need for booster doses is 'not yet
It's worth remembering that the ar - can sympathize with your enormous fully divined. ' And between 30 and 50
ticle to which you refer mainly con - anger and frustation. The late medical per cent of people vaccinated with
cerned the wisdom of launching a critic Dr Robert Mendelsohn maintained three doses of the vaccine lose de -
nationwide immunization pro - that the many long-term side effects of tectable antibodies within seven
gramme for infants. the live measles vaccine included multiple years. This could mean that you may
We went back to another panel sclerosis, juvenile onset diabetes and need a booster shot every five years
member, immunization expert An - Reye's syndrome. Reye's syndrome can for the rest of your life.
thony Morris, who authored the re - cause the degeneration of organs such as "Again, the AAP admits this with
port on vaccination. Here is what he the pancreas, particularly when aspirin the statement that 'the possible need
had to say. has been used. Mendelsohn once cited a for booster doses after longer inter -
"Most of the work in New Zealand batch of cases of Reye's syndrome in vals than five to seven years will be
was based on vaccines made from hu - Montreal in which five of the children had assessed as additional information
man plasma. However, as recently as been vaccinated within three weeks of becomes available.' Finally the AAP
the early 1990s, Smith Klein and coming down with the illness. In Shot a says that 'in 1-2 per cent of cases the
French was licensed to use the geneti - in the Dark (Avery), Harris Coulter also recommended regime . . . is not effec -
cally engineered vaccine, which is provides ample evidence of the relation - tive.' Therefore, infants should be
grown on yeast cells. However, the ship between pertussis vaccination and tested at nine months or later to see if
earlier plasma-derived vaccine was the failure of children to maintain stable it's taken. This means that 2 out of
never withdrawn, and even those glucose levels. Now that two of the MMR every 100 babies won't be protected by
drug companies which stopped pro - vaccines have been withdrawn, you might the vaccine.
ducing the blood-derived product get a legal opinion as to whether you "This high failure rate has been re -
kept selling it until it was used up. So have a case against the supplier. produced in adults; a study pub -
until very recently, anyone receiving While we applaud your determination, lished in the Journal of Infectious
the vaccine could have received a we would strongly urge you not to take Diseases (April 1992) showed that 10
blood-based vaccine. matters entirely into your own hands with per cent of volunteers vaccinated
"The other issue you raise concerns such a potentially serious condition . We failed to produce antibodies.
the safety and efficacy of the yeast-de - recommend that you work in partnership "There is also the possibility that
rived or 'recombinant' vaccine. You with a doctor with great experience in the hepatitis B vaccine can itself
say that the contents of our article treating diabetics nutritionally.Also, our cause a mutant strain of the virus. In
only applied to this earlier vaccine. issue Vol 3 No 7 on diabetes may be of a study in southern Italy published in

6 WDDTY Vol.3 No.8


the Lancet (11 August 1990), 44 of the coeliac disease, and even total atrophy
1,590 infants born of HB carriers be - of the gut lining. Title: Which? Medicine
came HB positive, 32 of whom showed "Commonly, patients with giardiasis
evidence of infection and one, serious have a deficiency of the enzyme lac - Author: Rosalind Grant
disease. The study group concluded tase, required to digest cow's milk, and
that the vaccine caused a viral ‘escape’ they may also fail to absorb folic acid ( Consumer's Association ) £12.99
mutation—ie, a slightly different or - and vitamin B12, leading to anaemia.
ganism resistant to the protective ef - "At the moment, diagnosis of giardia -
fects of the vaccine. sis is very difficult, since most labs do This rather expensive paperback aims to
"Finally, there have been reports (the not have the requisite detection skills. give a handy guide to the 80 most com-
Lancet, 25 April 1992) of people misdi - Routine hospital screening of faeces monly prescribed generic drugs and
agnosed as HIV positive after being for the presence of giardiasis misses advice on 1500 prescription and over-
vaccinated with the HB vaccine. " the diagnosis 98 per cent of the time.
In our view, the studies Dr Morris "A newer and probably better
the-counter medicines.
cites demonstrate that no definitive method, described by Bueno and Par - Its basic message is one which WDDTY
statements can be made as to the safety rish in the USA, consists of a superfi - fully endorses. Be an active patient, it
or efficacy of either the old or new HB cial biopsy of rectal mucosa taken by says. Ask your doctor questions and take
vaccine for children. means of a small cotton bud swab nothing for granted, it exhorts.
pressed firmly into the mucosal lining. As well as information on drugs, it sets
"There are various other, less com -
out 20 questions you should ask each
mon parasites, and because of the
deplorable state of diagnostic tech - time you are prescribed a drug.

For the past few years I've niques, doctors like myself consider it However, perhaps inevitably for a book
suffered from a number of a good idea—when parasites are the from the CA, it errs on the side of con-
bowel problems and almost likely culprit of a complaint—to try a servatism. The prevalence of side effects
constant fatigue. I've seen therapeutic trial of treatment to see if is played down, and it barely nods in the
allergy doctors and alterna- it helps. direction of alternative approaches. "Diet
tive practitioners, who have treated "For many of these organisms, the
me for possible allergies, candida al- metronidazoles (Flagyl) are the treat - does not seem to affect the course of
bicans and ME—all to no avail. Any ment of first choice. Therapy may need acne," it baldly states. The section on vi-
suggestions?—B. M., Shropshire. to be kept up for several weeks. Even if tamin supplements is headed pejoratively:
apparently successful, relapses are Money down the drain?
common, probably due to incomplete No doubt the author would point to the
eradication, rather than re-infection. question mark as proof of her impartial-
"A new drug, tinadazole (Fasigyn)
ity, but the same heading could have been

Have you looked into the pos - has become available and appears to
sibility that your problems be effective. Nevertheless, it may cause used equally well for many of the more
may be caused by an intesti - short-lived abdominal discomfort and orthodox treatments covered.
nal parasite? Allergy spe - drowsiness. Treatment should be
cialist Keith Mumby has avoided during pregnancy and breast -
done a good deal of work on parasites feeding, and patients under treatment Title: Inequalities in Health
and their treatment. Here is what he should avoid alcohol, which will make
had to say: them ill if taken concurrently with the Author: P Townsend & N Davidson
"It is now accepted by many clinical drug.
ecologists that as many as one in six "Herbal treatment can be strikingly (Penguin) £7.99
people in Britain may be carrying effective, particularly plants from the
around giardia lamblia, a minute, genus Artemesia. These are the worts, Just as the feminists used to say the per-
flagellated protozoan that causes se - such as wormwood (Artemesia ab- sonal is political, this book leaves you in
vere fatigue and bowel disturbance. sinthium) and mugwort (Artemesia no doubt that the state of your personal
Perhaps 10 to 12 per cent carry cryp - vulgaris). Moxa, used in moxybustion
health is political.
tosporidia infestation, a mild enough by acupuncturists, is from this group
infestation in healthy individuals but of plants. It brings together in one edition The
a potentially fatal one for those with "Best known as an antiparasitic is Black Report—which caused a political
compromised immunity, such as AIDS Artemesia annua. It is currently un - storm when it was published in 1980—
victims. der study by the WHO as a possible and an updated edition of The Health Di-
"The majority of patients simply get treatment for chloroquine-resistant vide by Margaret Whitehead.
vague, grumbling symptoms that come malaria. It is available as a bowel Both reports argue convincingly that
and go, never quite adding up to a ‘dis - preparation; usually, 1 gram is taken
ease' or something the doctor would three times a day for 60-90 days. Better governmental policies have a devastating
wish to have fully investigated. Most results may come from combining it effect on the nation's health. If you want
especially occur in the bowel, where with some other herbs. to have a long and healthy life, be sure to
mild symptoms of the ‘irritable bowel' - "Grapefruit-seed extract, known un - be rich, white and living in the South East.
type are quite common. However, sys - der several brand names such as It gives an excellent overview of the fac-
temic symptoms—particularly fatigue, DF/100, Parcan and Citrocida, has a tors which go towards shaping the pat-
lack of energy, muscle weakness, similar range of activity. The two com -
headache, sore throats, enlarged bine very well. If a short-term course of
tern of health care provision—just in case
lymph glands, night sweats and occa - Flagyl is added, this makes up just you thought it was determined by need—
sional fever—can be caused as well. about the best ammunition we've got." and explains how the medical establish-
"Giardia lamblia is an important "If a doctor diagnoses you as having ment conspires to ensure that so-called
cause of traveller's diarrhoea and a parasite and you respond to treat - fringe medicine remains there.
chronic fatigue. Patients with irrita - ment, it is vital to investigate other It also sets out a series of measures
ble bowel or ' food allergy' can often members of your family to prevent
government could take to improve the
date the onset of their symptoms to an cross-infection.
episode of tummy upset on a holiday “In the UK, rectal swabs and the health of its citizens; like uprating child
abroad. Bueno-Parrish method can be done at benefit, making clinics more user friendly,
"Giardiasis can cause severe malab - the London Clinic, 20 Devonshire Pl, and ceasing to conspire in the promotion
sorption, not unlike that caused by London WDN 2DH (tel: 071-723 6581)." of a major killer, by banning all tobacco

WDDTY Vol.3 No. 8 7


Testing the test

he first signs of an incipient pa- erto accepted as read in the medical com- ideal of the CCT is rather far removed
tients' revolt against the controlled munity, that "if it's good science, it will be from reality, by showing convincingly in
clinical trial (CCT) have begun to ethically good as well". Indeed, there are well-researched arguments that:
appear. Those are the supposedly airtight grave doubts that the CCT can even be ●In practice the CCT is at best a trade-
scientific studies in which patients are regarded as "good science". off between scientific and economic re-
randomly selected to be given either the Dr Harris L Coulter, the distinguished straints.
drug under study or a placebo. medical philosopher-historian, addresses ● Because the CCT is incapable of pre-
Last year, the Hastings Centre in New these sorts of issues comprehensively in a cise identification, accurate prediction or
York, an eminent medical ethics author- book entitled The Controlled Clinical valid specification—at best, it manages
ity, issued a 57-point table of recommen- Trial: an Analysis. no more than statistical correlations be-
dations, agreeing with the emerging Coulter concludes that it is seriously tween the ill-defined—it is not 'scientific'
healthcare activists that "there are cir- in any sense of the word.
cumstances in which other designs [radi- ●Its results do not affect physicians'
cally different to the CCT] are more prescribing patterns the way they are
appropriate". The (US) National Wom-
en's Health Network in Washington, DC,
‘The controlled supposed to do.
●Although misrepresentation and con-
is currently campaigning on two heavily
politicized issues in women's health. In
clinical trial is cealment are fairly common,there is no
fail-proof method of correcting the medi-
February 1992 it lobbied the Food and
Drug Administration (FDA) and
not scientific cal literature following fraudulent publi-
Congress over the safety of breast im-
plants, and is pointing to the inadequa-
in any sense ●The CCT is dehumanizing: patients
become the objects of a scientific quest,
cies of the clinical trials that preceded
this dubious procedure. In May 1992 ac-
of the word .’ are treated with aloofness and are seen as
a source of irritation if they turn out to be
tivists were at the National Cancer Insti- individual deviants from the sample-
tute, voicing their well-founded concern flawed in every fundamental norm).
over the design of a clinical trial of a drug respect.First of all there are a variety of ● A doctor's ability and duty to observe
to prevent breast cancer in healthy practical problems, for instance: is consistently subverted by the assump-
women. Healthcare campaigners are get- ● Confusion in international terminolo- tion now in medicine that the only reli-
ting participants in CCTs to have their gies makes it very difficult to make com- able source of information is the CCT).
tablets analyzed in order to find out parisons in investigations. Clearly, the days of trying to make all
whether they are getting the real drug or ●Reliability is compromised by the pharmacological questions fit the CCT's
a placebo, and some participants then enormous costs (and financial rewards) of unwieldy and very expensive mould are
share their drugs with others. engaging in CCTs that contribute to now numbered, not least by the economic
These developments represent a con- many inadequate protocols and the cor- reality of the horrendous cost involved for
certed challenge by those who champion ruption of not a few investigators. often such paltry bits of information. It is
the rights of individuals against the col- ● An idiosyncratic variety in the health this which may hasten the displacement
lective ethic of science, represented here and disease of humans presents insuper- of the CCT in the foreseeable future.
by the controlled clinical trial. able difficulties in interpretability of CCT Harald Gaier
Behind all these individual rumblings results. Harald Gaier, author of The Ency-
is the first challenge to the notion, hith- Coulter demonstrates that the utopian lopaedic Dictionary of Homoeopathy.

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8 WDDTY Vol.3 No.8