Category Archives: ethics

Blow up the pokies

Regular readers of this blog, and I know there are at least two of you, may have noticed that I have changed the URL away from WordPress.com. Why? Because WordPress carry ads for gambling, and I lost a family friend to gambling debt related suicide. Gambling is a particularly pernicious problem in Australia, as the blow chart shows, and is linked to around 20% of suicides.

http://www.economist.com/blogs/graphicdetail/2015/09/daily-chart-0
http://www.economist.com/blogs/graphicdetail/2015/09/daily-chart-0

This is made worse by Governments and large companies. And that’s why I no longer host at WordPress.com.

If you are feeling suicidal or need help, some resources in Australia are:

 Lifeline: 13 11 14
www.lifeline.org.au

Suicide Call Back Service: 1300 659 467
www.suicidecallbackservice.org.au

beyondblue: 1300 22 4636
www.beyondblue.org.au

The paleodiet won’t cure you, hunter gatherers died of cancer too.

Prof. Alice Roberts writes in The Incredible Unlikeliness of Being (Amazon, iTunes):

…recent changes in our digestive physiology mean that the whole idea of a ‘paleodiet’, purportedly healthier because it recreates the diet we evolved to eat as hunter-gatherers, is off the mark. Firstly diets would have varied from place to place, even back in the Palaeolithic, and many populations have changed genetically since we left that way of life behind. We are not fossilised hunter-gatherers.

Speaking of fossilised hunter-gatherers, although they’re hard to come by, as fossilisation needs the right conditions, they do exist. Most won’t show any signs of cancer, because soft tissues are not preserved. Of the cancers that do typically metastasise to bone, these (prostate, breast, and lung cancer) tend to occur in old age, and hunter gatherers didn’t tend to live long, nor smoke. But here’s one of the earliest examples I could find, a remarkable, but sad case, of an bronze age, hunter gatherer, adult male with a large number of bone metastases, some of them  pictured here:

bone metasteses

Why is this remarkable specimen relevant to today? Because it’s one piece of evidence that a paleodiet (as in, the current trend, as distinct from what hunter gatherers actually ate) won’t prevent cancer, although a generally healthy diet can play a role in preventing some types of cancer. You’d need to speak to a qualified dietitian, not naturopath or chef, for advice on what’s right for you. Furthermore, diet won’t help cure cancer, however as we’ll see you may need listen to proper advice on diet for your type and stage of cancer.

So it’s disturbing to find this advice from naturopath Sarah Stevens on paleodiet chef Pete Evan’s Facebook site, which reads in part:

Specialising in Integrative Oncology is such a rewarding yet frustrating area to work in as I am constantly battling against dietary recommendations from the hospital DAA dieticians who recommend high sugar carbohydrate foods to maintain weight and energy. I am also constantly battling with the message that gets brought back to me that my client is not eat the food plans I recommend as they are “dangerous” and can make them worse! This approach is based of “fear of the unknown” rather than research. It is clearly stated but the World Health Organization (WHO) than an estimated 40% or more of all cancer can be prevented. Dramatic increases in lifestyle risk factors such as un-healthy eating habits and obesity are major contributing factors generally due to a high refined carbohydrate, high hydrogenated (trans) fat and low protein/fat diet.
If I could do one thing to change our conventional dietary treatment for cancer it would be cutting out sugar and refined carbs from the dietary recommendations. In my practice I use a Ketogenic and whole food eating program and have only seen my clients improve in wellbeing, maintain muscle mass and healthy gut function while giving them better quality of life and their bodies the tools to heal…

Food and nutrition are a powerful medicine to heal and repair the body. I encourage you to follow a clean diet; eliminating processed foods, sugars, preservatives and additives. Foods that are in their original state, straight from the tree, ground or animal without being changed or processed means that they are full of phytonutrients, antioxidants, good oils and high in fibre. Choosing whole foods is the basis of a healthy lifestyle.

In other words:

  1. Claims that the paleodiet prevents cancer;
  2. Claims that the cancer patients who need to be on a particular diet to maintain weight and energy, which are important for treatment and quality of life, should actually be on a paleodiet; and
  3. Claims that food can act as a ‘powerful medicine’ for cancer.

As dietitian Kate Van Berkel wrote in a comment on that Facebook post:

I find it incredibly upsetting that Dietitian’s spend professional development time learning how to work along side naturopaths and then receive this sort of response.

I have specialised in nutrition and oncology for 6 years. I work with world class consultants who are holistically focused. As a specialist dietitian I am not only well read, but am also actively involved in further research into the role of nutrition and cancer. This is no blanket approach, and I have NEVER used the Australian guide to healthy eating with an oncology client as the guidelines are not developed for anyone with a medical illness.

Unfortunately with xerostomia, dysguesia, anorexia, nausea, delayed gastric emptying, and severe fatigue, for a lot of the clients a “healthy diet” just will not cut it.

I have worked with thousands of truly inspirational clients who try to eat a wholesome diet and lose 1-2kg a week with a substantial amount of lean body mass disappearing as well (it’s hard to have any quality of life with that going on).

Overwhelmingly current clinical evidence points to weight and muscle loss being the single worst nutritional factor when it comes to cancer survival rates. Evidence also points to the fact that the breakdown of muscle mass released nitrogen which may fuel cancer cell growth.

If my clients are able to eat a healthy diet in whatever form (Paleo or otherwise) it may take, fabulous.

If they are down to liquid foods and a few mouthfuls of solid foods a day (common for some types of cancer) I will not hesitate to use a carefully selected formulated high energy, high protein liquid meal replacement (such as eek! Sustagen/Enprocal/Resource/fortisip/). If it helps to improve the chance of survival, bring it on!

This is what I do, and I love it because I see specialist dietitians helping people maintain their strength, hope and dignity every day. It’s an amazing profession to work for in a setting that is otherwise very “clinical” and medication based.

I encourage anyone going through cancer treatment who is worried about their nutrition to have an open conversation with an oncology dietitian. You can take or leave the recommendations, but at least be fully informed and empowered.

To all the family members reading this, be mindful of pushing your loved ones into your way of eating. In a private clinic many of my clients admit to feeling distress over being pressured into eating foods that they just cannot face from loving but misguided family members. Allow flexibility and make the effort to go to the dietitian with them so that you can speak about your concerns.

Thanks
Kate

Given I share Ms Van Berkel’s concern, I wrote to the Victorian Health Services Commission, who advised:

Under the Health Services (Conciliation and Review) Act 1987, our office receives and deals with complaints from patients or consumers of a health service. While we respect and register your concerns regarding Ms Sarah Stevens we are unable to accept your complaint as a third party. Please appreciate, in these circumstances, our powers are limited. As you did not directly and are not complaining on behalf of someone, who did
receive a health service, this matter is not within our jurisdiction.

While our office may not be able to assist you in investigating these concerns, there are other organisations that will be able to help you to ensure that your concerns are addressed. We have noticed that Ms Stevens has stated she is a member of the Australian Natural Therapists Association (ANTA).

ANTA have standards of practice and a complaints process that registered members must abide by. I would respectfully like to refer you to bring your concerns to the attention of the Australian Natural Therapists Association;
You may also wish to write to them at Australian Natural Therapists
Association, PO BOX 657, Maroochydore QLD 4558 or alternatively, email them
at info@anta.com.au
Further details can be found at this web site:
http://www.australiannaturaltherapistsassociation.com.au/about/complaints_handling.php

You also stated that you believe Ms Stevens is providing dangerous advice;
these concerns can also be lodged with Consumer Affairs Victoria.
Their details can be found on their web site at
http://www.consumer.vic.gov.au/contact-us/make-a-complaint.
If you wish to write to them, their address is located at Consumer Affairs
Victoria, GPO Box 4567, Melbourne VIC 3001
They can be contact on telephone number 1300 558 181 or by email at
consumer @ justice.vic.gov.au

I hope this information was of assistance to you.

So I wrote to the ANTA:

Dear Sir/Madam,

Based on this Facebook post, https://www.facebook.com/paleochefpeteevans/posts/793442640749124
(pdf copy attached), I am deeply concerned that Sarah Stevens, a naturopath operating from Armadale, Victoria, is
1. Providing dangerous advice to the public at large, and
2. Providing dangerous advice to individual cancer patients,
that could seriously compromise their health, even resulting in death, through improper nutrition contrary to proper evidence-based medicine in that area.

I strongly urge you to investigate Sarah Stevens and also issue a public warning on this issue.
I note in particular your quality policy and mission statement (copied below) as well as your scope and standards of practice.
ANTA QUALITY POLICY
ANTA is a quality organisation and aims to deliver quality service at all times.

ANTA MISSION STATEMENT
ANTA’s mission is for Natural and Traditional Therapists to uphold and advance their standing within the community and to provide the public with best practice health care in all disciplines in Natural and Traditional Therapies.

Regards,
Dr Matthew Berryman

The ANTA wrote back:

Dear Dr Berryman

I am writing in response to the complaint you have lodged with the Australian Natural Therapists Association (ANTA) regarding Sarah Stevens.

Sarah Stevens has not renewed her membership with ANTA and is not a registered practitioner/member with ANTA.

As Sarah Stevens is not a member of ANTA, we recommend you lodge your complaint with the Office of the Health Services Commissioner at the following link:

http://www.health.vic.gov.au/hsc/resources/infosheet.htm

Regards

Brian Coleman
Executive Officer
Australian Natural Therapists Association Ltd (ANTA)

Now as her web site does clearly state she’s a member:
Sarah Stevens, registered ANTA memberI wrote to the Luxton clinic where she works:

Dear Madam/Sir,

On the “about” page for Luxton Clinic, it states “Sarah has a Bachelor of Health Science, post-graduate Nutrition Medicine qualifications and is a registered Naturopath with the Australian Natural Therapists Association (ANTA).”, however ANTA state otherwise in the email below.

I look forward to your amendment of this statement, lest it be reported to Consumer Affairs Victoria for misrepresentation in advertising.

Regards,
Dr Matthew Berryman

and Ms Stevens advised:

Hi Matthew,

Thank you for your email regarding my membership with ANTA. I have contacted ANTA and there had been a clerical error in their system which has been corrected today and my membership is still current and effective for my qualifications to date.

I wish to thank you for bringing it to my attention as I was not aware that there was an issue and have spoken to ANTA and my details will be updated on their website in the next 24-48 hours.

Kind Regards,
Sarah

I then wrote on the 11th of March:

Dear Mr Coleman,

Ms Stevens has indicated in the attached email that she is in fact a registered member of the ANTA. That being the case would you please reopen the investigation.

Regards,
Dr Matthew Berryman.

Not having heard anything by the 10th of April, I wrote back to Mr Coleman:

Dear Mr Coleman,

When do you expect the investigation to be complete?

Regards,
Dr Matthew Berryman

and was advised:

Dear Mr Berryman

The matter will be reviewed at our next meeting on the 15th May 2015.

Regards
Brian Coleman

So what was the finding, following all of that?

Dear Dr Berryman

The ANTA Ethics Panel and ANTA National Council reviewed your complaint and the response from Sarah Stevens and decided no breaches of the ANTA Code of Ethics or ANTA Constitution had occurred and no further action is to be taken.

Regards

Brian Coleman

Hoping for at least a little transparency as to why the ANTA finds it both best practice and ethical to provide advice that is contrary to evidence-based practice, I wrote to ask:

Dear Mr Coleman,

Could you please send me a written copy of your findings as well as the response from Sarah Stevens (the only response I received from her as you know was not addressing the issues but pertaining to her membership).

Regards,
Dr Matthew Berryman

however the ANTA are less than transparent:

Dear Dr Berryman

I have advised you of the findings in my email below. Under our rules and regulations, we are not required to provide a copy of the response by our member.
ANTA National Council has advised the matter is now closed.

Regards

Brian Coleman

I also ran Ms Stevens’ Facebook comments past Tim Crowe, Associate Professor in Nutrition from Deakin University who wrote:

Although good nutrition is important to help a person get through cancer treatment and to manage the sometimes-severe side-effects of treatment, there is no reliable evidence of any form of nutrition therapy ‘curing’ cancer. Yet there is a wealth information – some good and some very misinformed and dangerous – that a person with cancer may read or hear about as to what they should eat when they have cancer. It is best to get information about nutrition and cancer through organisations such as the Cancer Council http://www.cancercouncil.com.au/ or an Accredited Practicing Dietitian.

Quite.

Universal Medicine cult wins Lismore Chamber of Commerce’s People’s Choice Award

Upon learning that the Universal Medicine cult recently won the Lismore Chamber of Commerce’s People’s Choice Award, I wondered whether it was as a result of vote spamming, as they have a prior form for that. So I wrote to the Lismore Chamber of Commerce to enquire further about their win:

Dear Madam/Sir,

I am writing an article on Universal Medicine winning the Lismore Chamber of Commerce’s People’s Choice Award, and invite your response on the following questions:
* Do you have any comment on the fact that a new-age esoteric breast and ovary massage “healer” group has won the People’s Choice awards?
* Do you think it reasonable that a charity is eligible for this award, instead of restricting eligibility to regular Lismore business for this award?
* Who was eligible to vote in the People’s Choice award?
* What if any measures were taken to prevent vote spamming by members / followers of this group?

Regards,
Dr Matthew Berryman

I received the following response:

Dear Dr. Berryman
Re your email of Aug. 25th concerning the People’s Choice Award, the general public voted for their chosen business (s) so the award went to the business that received the most votes…just like an election. The voting rules were publicised prior to the awards night and the Chamber had nothing to do with the selection of the winning business…it was as the name implies, The People’s Choice Award.
I hope this answers your questions satisfactorily.

So, in other words, they have no comment other than to point out the eligibility criteria for votes, which are simply that anyone could have lodged a vote through either the Lismore Chamber of Commerce’s Facebook page (poll obviously no longer appears) or through a nomination form available from the Northern Star newspaper. Thus, it was open to spamming by any business—and Universal Medicine is registered as a business, apparently you can sell kooky beliefs—that can get members / customers to vote. Their win is just further evidence of the grip they have over their members, and I wonder in the absence of that which deserving Lismore business might have won this award.

Facebook, hate speech and child abuse

Warning: I felt nauseous and cried putting together some of this material.

First, let’s review Facebook’s definitions of violence and hate speech:

Facebook definition of violence
Facebook’s definition of violence
Facebook's definition of hate speech
Facebook’s definition of hate speech

I’d like to know how the below comment, on Meryl’s links to Big Oil and Big Pharma (she sells tupperware and cosmetics, the former made from oil, and L’Oréal owns (owned?) a “big pharma” company, Sanofi-Aventis), can be considered hate speech or a threat.

MD comment

Of course, that’s not the first time that Meryl’s made frivolous complaints to get material removed. But, moving on to more serious matters, I recently became aware of one member of the anti vaccination (antivax)/antifluoride/other conspiracy theory community making threats by private message:

Frankie's a nasty guy
Frankie’s a nasty guy

When the person the message was sent to had done little more than post polite responses to antivax people on public Facebook pages. Yet, after Facebook reviewed a complaint about that message, they found it didn’t breach their “community standards”. Some community if that’s acceptable.

Even more worrying, is that Facebook allows a group for the promotion and discussion of child abuse to stand. First, let me make a few things clear:
I do not consider antivax people in general to be child abusers. Misguided, certainly, but there is usually no intent to cause harm to a child—they simply believe that vaccines are ineffective and dangerous, which is not true, but still, that’s what these people believe. And most are otherwise taking on board other measures, often useful. Example:

not child abuse
not child abuse

What I do consider child abuse is when parents, some of whom are happy to be vaccinated themselves, want to deliberately infect their children with diseases that they know full well are at best very unpleasant, and worse carries the risk of serious complications, including death. These parents have intent to harm their children, no matter how much they want to brush aside the risks of complications.

Before we jump in to look at this child abuse group that Facebook considers to meet “community standards”, let’s review a few extra facts on a couple of diseases and the vaccinations for them.

Here’s a primer on Chicken Pox (Varicella), and, particularly in high risk groups (which includes infants), it carries risk of complications. Measles is also nasty, and even in otherwise health people carries the following complications:

About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. About one out of 1,000 gets encephalitis, and one or two out of 1,000 die. Other rash-causing diseases often confused with measles include roseola (roseola infantum) and rubella (German measles).

No, Vitamin C (or E) won’t help you, and vitamin supplements have a long history of health myths. Nor are better nutrition and hygiene alone responsible for the reduction in disease. Compared with the risks of the MMRV vaccine that prevents both measles and varicella (chicken pox) along with mumps and rubella (German measles), the benefits (outlined in articles above) are huge. Vaccines aren’t linked to an increase in allergies, or cœliac disease or in autism.

Stats and science are important, but somewhat pale in comparison with these descriptions of cases in ICU from an Intensive Care Specialist:

I am an Intensive Care Specialist. Although it was a while ago now, I do remember my first job in Intensive Care (ICU). During my first week I admitted a young man onto ICU with chicken pox. He was 18-19, a young, fit, healthy, tradie. He liked football (soccer – it was England), and had never had any major illnesses before. He was fully vaccinated according to the schedule of the day (this was in the late 1990’s). This was in the days before there was a vaccine for chicken pox. He had chicken pox pneumonia, and was in respiratory failure as a result of this. He was struggling to breathe, and working really hard just to get the air in and out of his lungs. We had to give him an anaesthetic, and put him on a ventilator to try and keep him alive. At that time I had no idea that chicken pox could be so dangerous. I knew it was contagious, I mean, although I had escaped with mild disease when I was a kid, I remember that 26 of my class of 28 kids were off school at the same time with it. I hadn’t remembered learning specifically about it at med school, but I certainly did some reading during that first week on ICU.

It is not unusual, or rare, for it to cause pneumonia of such a severity that it requires hospital care. Not all that get it survive. He was ventilated for a couple of weeks. He, and his family, suffered terribly during that time. He was lucky though. He did survive. His lungs will be permanently scarred though, and I’m not sure he’ll ever play football again. He was the first patient I looked after in ICU with a vaccine preventable disease. The first of so many. The last was only this week, when I tried to help a gentleman with shingles. Shingles is excruciatingly painful, and also caused by the varicella virus. Thankfully, both these diseases are now preventable by vaccination.

So, without further ado, here’s the group for people (currently 482 members) who want to deliberately infect their kids with chicken pox (and in some cases as you’ll see, measles):

Chicken Pox Party group overview
Chicken Pox Party

Here’s a selection of the discussion I recently obtained from this closed group:

1 2 3 4 5 6 7 8 9 10 11

This next one is hugely worrying. Not only are they planning on trying to get a 5 month old infant infected with chicken pox (recall: one of the high risk categories for complications), they are also planning on giving said 5 month old chiropractic treatment to help manage the disease. Not only do they quote the disproven (and nonsensical) vitalistic theory behind false chiropractic claims; there is no evidence that any chiropractic treatment is of value in children and carries with it the risk of spinal injuries (which can lead to death).

Dr Pappas said he was concerned the decision was an endorsement of chiropractic treatment for infants when there was no scientific evidence to support it.

”I think they have put the chiropractor’s interests before the interests of the public,” Dr Pappas said. ”[Treating infants] is inappropriate and it carries a very small but real risk of causing damage, and in some cases, devastating damage.”

A review published in the Pediatrics journal in 2007 also found serious adverse events relating to spinal manipulations in children, including a brain haemorrhage and paraplegia.

12 13 14 15

There are some group members also interested in infecting their kids with measles:
Measles

and, despite warnings in the group description and from members (who seem more concerned by the illegality than the public health hazards), those who still seem keen on sending chicken pox via the frigging postal system and provide strategies on minimising detection (presumably the US post are on the lookout for licked lollipops alone):
Cp in the mail

Also noteworthy is this discussion, bearing in mind the extra risks to pregnant mothers and unborn children from chicken pox. At least the mothers have naturally acquired immunity (unless for some reason they didn’t—these cases do occur).

CP in pregnancy

Even if you disagree with me that the above is child abuse, there is still no clear category to report child abuse discussion on Facebook:

reporting options

and Facebook thus decide that the Chicken Pox Party group meets their “community standards”:

CP group Ok by FB

And just in case you think this is a US phenomena, behold parts of this discussion (in the following images) I found on public pages between Australian Facebook users:
chicken pox6

Come on Facebook, lift your game.

Vox FM: Voice of the anti-vaxxers, not the voice of the Illawarra

I wrote the following on the Vox FM Facebook page:

Everyone is entitled to their opinion, but not all opinions are equally valid, and I’m surprised to hear you ran the misleading and dangerous views of Meryl Dorey. Perhaps you should consider the effects on disease transmission rates in the community from airing her views, particularly since many of the children in the child care centre next door to Vox FM are on partly immunized. [And in case it’s not clear: this comment isn’t defamatory about Meryl, since the truth is a defence under NSW law.]

Vox FM then, rather than addressing my comments, deleted them, and then made a post saying:

Regrettably some people have recently been banned from this page & comments removed. This has come about not because of their position on a recent Vox interview but rather the way in which they stated their position. Their cause would be aided immeasurably if they chose to debate the issues at hand instead of making personal attacks on the interviewer, interviewee & indeed the station.

PS Whether these people had a genuine interest in Vox is questionable given they live interstate.

Vox FM: The issue here is that you broadcast unchallenged the views of someone not qualified to speak on vaccinations, and this is dangerous. Also, for the record, I’m not interstate, I live in Wollongong.

Oh, and one more comment they deleted, by Mike Mayfield, worth repeating:

Maybe so, Vox FM, but not everyone who has a proven track-record of attempting to deliberately mislead the public is entitled to masquerade those attempts as “opinion” on the radio and remain immune from criticism. Perhaps you should better research the background of your guests next time, so that you can inject some truth into the debate either during or after their interview.

Update: Since Vox FM now state that they only accept complaints to their PO Box, despite this not being stated on their contact page (complaints out of sight = out of mind? I wonder what the ACMA make of their complaint handling process, I will be writing to their snail mail address (via registered mail for tracking, and at my expense) on Monday with the following complaint:

Dear Sir/Madam,

I wish to make a formal complaint about your interview of Meryl Dorey. Her views as expressed on the show have no basis in scientific research, and it is dangerous that you allow them to be aired unchallenged. I request that you interview a qualified medical research / medical doctor and allow them to respond to Meryl Dorey’s claims. I request that you put her claims to them in writing before-hand to allow for a proper response. Please keep me informed via email to mattjb at me dot com of all steps taken as part of that process, and give me advance warning of at least one day, when you will air the response.

I also wish to complain that you not only ignored, but deleted my complaint on your Facebook page. You list the Facebook page on your contact page, http://voxfm.org.au/contact.html , and do not state there (as you now do on Facebook only, after ignoring my complaint made on your Facebook page), that you accept complaints only in writing to your PO Box.

Regards,

Dr Matthew Berryman

Figtree, NSW 2525