CONTROL YOUR HEALTH
,JNC 19`1G
The test for cervical cancer may well be doing more harm than good,
The smear
claims an expert at Dublin's Trinity College .
campaign
Recently, I received another "Dear Ms.
McTaggart" letter from my doctor invit-
ing me to come in for a cervical smear
test, this one a bit more insistent ("I
would like to stress how important it is to
have regular smear tests . . .") since I'd
ignored an earlier reminder. It arrived
with a Health Education Authority
leaflet claiming that of the many women
who die from cervical cancer every year,
"nine out of ten of these have never had
the simple, quick and painless test that
might have saved their lives."
Like most women, I carry around this
image of cervical cancer as a sort of
anti-ballistic missile, able to strike ap-
parently randomly at any moment.
This anxiety is largely propagated by
pamphlets like one I picked up recently,
sponsored by Durex (and, not sur-
prisingly, advocating the control of
cervical cancer through the use of barrier
contraception) : "Unfortunately," it
reads, "cervical cancer could happen to
almost any woman, for no one knows
exactly how it is caused."
And also like most women I have
grown up with the notion of the prime
facie benefits of the Pap smear, named
after a fellow named George Papanico-
laou, who first developed it. This simple,
relatively painless test involves scraping a
small sample of tissue from the neck of
the womb, and sending a slide of it to a
lab for analysis . I have been led to believe
that I can strike this particular ailment off
the list of potential deathbed scenarios,
Special report : Smear Tests
The test for cervical cancer is
probably doing more harm than good .
Guest column: Deborah Jackson
Theculpritin cot deathmay well be the cot.
kY hat Doctors Don't bell You, d Wallace Road, London 1t 2PG . Editor Lynne McTaggart Reporter at Large Anon Verghis Editorial Assistant Amanda Hibbs I xpexi h% Bidder
Bone & Cliffs Ltd printed b% McCarthy Information Ltd. publisher Bryan Hubbard. Cc Start Enterprises Ltd . No part of this publication max he reproduced -shout permission .
`The test is so
inaccurate as to
be virtually
pointless.'
with periodic tests like this around to
catch it well in time .
Under Britain's current, haphazard
screening programme, some three mil-
lion smears are performed every year, at
an estimated cost, if doctors, nurses' and
lab time is figured into the total, of £to to
00 per woman screened . Although there
is no overall national government policy,
most GPs regard cervical cancer screen-
ing as part of standard good practice,
recommending that all women between
the ages of 2o and 65 repeat the test every
three to five years. An article recently
published in The Lancet (13 January
1990) now recommends that the screen-
ing be carried on in women over 65,
considered a high risk group.
The pap smear has even become a
feminist issue, with advocates claiming
that a well organized screening pro-
gramme would save the thousands of
women lost every year to the disease,
C O N T E N
Patients get struck of
doctors and HRT;
what doctors read .
Q&A: Dietary treatment
for multiple sclerosis.
VOLUME i, NO . 3
particularly among the poor, considered
most at risk . ,
And under the new NHS regulations,
we can expect more intense pressure on
women to take the test with greater
frequency as the fee-per-smear-test-
performed becomes part of a doctor's
bread and butter work . (After 1 April
doctors get bonus pay only if more than
So per cent of the women on their lists
receive the tests and triple the bonus pay
if 8o per cent take it .) But who would
quarrel with the benefits of a simple,
painless, risk-free test that promises to
eradicate a common killer of the fair sex?
Professor James McCormick of the
Department of Public Health at Dublin's
Trinity College, for one, would. In an
article published in The Lancet in its
"Dogma Disputed" section, Professor
McCormick, after studying much of the
available medical literature on the sub-
ject, concluded: "There is no clear
evidence that this screening is beneficial,
and it may well be doing more harm than
good."
With Professor's McCormick's assis-
tance, WDDTY also studied the medical
literature and came up with the following
conclusions .
Cervical cancer is not the massive killer
it's often made out to be. Although some
2,000 women get cervical cancer every
year, that represents less than one-sixth
of the number of women who contract
breast cancer. In The Health ,Scandal,
author Dr Vernon Coleman (see p.8)
T S
Books: Planning for a Healthy Baby;
Food Allergy and Intolerance; special
offer for WDDTY readers.
Second Opinion: Vernon Coleman
The Marketing of Medicine.
says that cervical cancer doesn't even
make the top to causes of death among
women, falling behind breast, lung,
colon, stomach, ovarian, even pancreatic
cancers .
The entire smear campaign may be based
nn a faulty assumption. that abnorma4 or
"precancerous"; cells on the cervix lead to
cancer. This has been presumed because
medicine knows that cervical cancer
progresses slowly and that if caught early
enough it can be cured. There are four
categories of abnormal lesions, or "cervi-
cal interstitial neoplasia" : CIN I, II, III
and cancer.
What we don't know is whether the
early lesions - that is, those
in the CIN I and II categories - will go on
to develop cancer, or even what to do
about them . Professor McCormick cites
a study published in the British Medical
journal examining the accuracy of cytol-
ogy screening. The study demonstrates
that some to per cent of women screened
have cervical abnormalities, "most of
which," says Professor McCormick,
"would not progress to cancer."
Medicine also doesn't really understand
the usual progression of this kind of cancer.
Some cervical cancers appear to regress if
left alone, while others progress so
rapidly that the three to five year gap
recommended by most screening pro-
grammes would fail to pick them up in
time. Dr Coleman points to a tg78 article
published in The Lancet which conclud-
ed that one-third of all biopsies (one of
the treatments for cervical cancer, in
which a portion of the cervix is removed)
are likely to have been performed on
lesions that were either inconsequential
or likely to disappear if left alone.
The test hasn't been shown to save lives
its am countn, inhere it has been in-
troduced. If the Pap smear were saving
those 2000 lives lost every year, no one
would quarrel with the programme. To
date, however, there has never been the
sort of randomized controlled trial ne-
cessary to prove it is actually doing any
good .
In fact, every study shows the oppo-
site . The only area in Canada, for
instance, where screening has been
universally adopted is British Columbia,
nevertheless, the death rate of cervical
cancer there matches the death rate of
the rest of the country.
In the UK, the death rate fell before
the test was introduced and has remained
stubbornly at this 2000 figure ever since.
And there is no evidence to support the
common contention that things would be
worst but for the test . Dr Coleman claims
the test only saves between five and seven
per cent of women with the disease.
The test itself is so inaccurate as to be
virtually pointless. There is no guarantee
that the test will pick up the fact that you
have cancer and a fair likelihood that you
will be given a false positive - that is, told
you have an abnormality that doesn't
exist. In the aforementioned January 13
Lancet article, the authors admit to false
negative rates of between 7 and 6o per
cent .
The reason the test is so unreliable,
`Interpretation
varies widely,
depending on
who is looking
at the slides .'
says Professor McCormick, is that inter-
pretation of results varies so widely,
depending on who is looking at the
slides . You could even get a different
interpretation from the same person
looking at the same slide on separate
occasions. This is particularly so, says
Professor McCormick, for "the minor
changes that give rise to most reported
abnormalities" .
Then there is the problem of large
numbers of smears being technically not
up to scratch . Dr . Coleman cites an
article in Modern Medicine by Dr.
Chandra Grubb, who heads the Depart-
ment of Cytology at the Royal Free and
University College Hospital in London .
Dr. Grubb reported that some to per cent
of all smears sent to cytology depart-
ments are useless and a further 40 per
cent, of limited usefulness because doc-
tors haven't taken the smear correctly or
have taken it from the wrong site .
Screening tests such as the Pap smear
are judged on the basis of their sensitivity
(ability of the test to detect the disease)
and specificity (its ability to identify
those who don't have it). On both
accounts, concludes Professor McCor-
mick, "this test is useless" .
With this kind of poor batting average,
we're probably subjecting large numbers of
healthy women to potentially risky treat-
ments. The conventional treatment for
early "precancerous" lesions employs a
colposcopy (a magnifying glass with
light) and biopsy, diathermy (where heat
is used to burn the abnormal cells) or
cyotherapy (a freezing probe which
freezes the outlaw calls). These pro-
cedures can all cause hemorrhage, an
incompetent or narrowed cervix, which
will affect a woman's ability to carry a
pregnancy full term, and unnecessary
hysterectomy.
In Male Practice: How Doctors Man-
ipulate Women, Dr Robert Mendelsohn
tells the story of a colleague of his whose
wife received a positive reading. She
went ahead with a cone biopsy, which
caused such excessive bleeding that she
had to have an emergency hysterectomy,
during which she almost died from the
anaesthesia. All because of a test that
might have been wrong in the first place!
Speaking of hysterectomy, it can also
be carried out as a just-in-case measure,
says Professor McCormick. Echoing the
views of many doctors, the Durex
pamphlet on the subject blithely suggests
that hysterectomy may be the treatment
of choice for "women who have completed
their families" (italics mine). Professor
McCormick also mentions the published
reports of the risks of cross infection from
improperly sterilized speculums, the
instrument used to perform the test .
So how do you protect yourself against
cervical cancer, or - more importantly
- the test itself? Professor McCormick
says the most important early warning
(early enough in most cases, for treat-
ment) may be any sort of inter-menstrual
bleeding, for instance, after coitus or a
persistent vaginal discharge. The likeli-
hood of cervical cancer increases with
the number of sexual partners, smoking,
taking the Pill or other estrogens, wheth-
er you've had any sexually transmitted
disease or begun your sexual life early.
If you don't fall into any of those
categories, be wary of your doctor
pressurizing you into taking the test,
particularly as he now stands to benefit
financially from it. And if you get a "Dear
Patient" letter, you might respond with a
"Dear Doctor" letter, explaining that
you do not wish to be subjected to a test
that has never been shown to do any
good and certainly is doing some women
unnecessary harm .
Lynne McTaggart

Dying of loneliness
by Deborah Jackson
Many thousands of pounds are chan-
nelled into studying the possible reasons
for the Sudden Infant Death Syndrome.
SIDS, also know as "cot death", accounts
for up to half the deaths of children in
Britain between the ages of one week and
two years. Ninety per cent of the babies
die before they reach nine months.
Apart from hints that breastfed babies
are less likely to die from SIDS, that
outdoor deaths are more common in
winter, and less in Sweden, and more
babies die on a Saturday, no one really
knows when cot death will strike . But it
appears that children in some societies
are far less likely to die from the
syndrome than others .
French birth pioneer Michael Odent,
travelling in China in 1977, asked medi-
cal professionals about the pheoomenon
of cot death. No one knew what he was
talking about. Later, in correspondence
with The Lancet, Dr Odent reported his
findings : ". .. the concept of sudden
infant death . . . was apparently unknown
among professionals and lay people in
such different places as Peking, Hsian,
Loyang, Nanking, Shanghai, and Can-
ton. Furthermore I learned that Chinese
babies sleep with their mothers, even in
the most westernized families . .. Ever
since then I have held the view that, even
if it happens during the day, cot death is
a disease of babies who spend their
nights in an atmosphere of loneliness and
that cot death is a disease of societies
where the nuclear family has taken over."
(The Lancet, as January 1986).
In a high density city such as Hong
Kong, where families are crowded into
high-rise apartments, infants are rarely
alone. Professor D.P . Davies, a paediatri-
cian working in the Prince of Wales
Hospital in Hong Kong, is the author of a
study demonstrating that cot death is
rare among the Chinese community
there. He concludes that the crowded
lifestyle of the Chinese population in
Hong Kong may play an important part
in keeping SIDS at bay. His findings are
particularly surprising, because most
babies in Hong Kong are bottle-fed,
overheating is common in the hot and
humid climate, and many children suffer
from respiratory illness . These are all
factors traditionally believed to contri-
bute to the likelihood of cot death.
It is also known that SIDS is rare in
Malaysia and among North American
Asians . These families share many sim-
ilarities in the raising of their children,
including sleeping with them while they
are small. Many Asian families in the
West live in extremely crowded con-
ditions. Children and babies may have
no choice but to share bedspace.
So what could be the connection
between solitary sleeping and SIDS?
Susan Band, administrator of the Foun-
Tbrrs t» a Bed
thrl owpr# In cot
Cot its'
clodloofto
dation for the Study of Infant Death, says
that SIDS is "just as likely" whether the
cot is in the parents' bedroom or in a
nursery. In neither case does the baby
have genuine long-term contact with
another human being. It could be that the
cot itself is a factor in cot death.
In his paper, An Anthropological
Perspective on SIDS, medical anth-
ropologist James McKenna of Pomona
College, Claremont, who leads the field
of research into the holistic answer to
SIDS, gathers a wealth of evidence that
supports this thesis. The foetus begins to
breathe rhythmically up to three months
before birth. Studies have shown that
sensory stimulation (e .g . the rocking of
the mother as she walks) keeps the
unborn child breathing regularly.
At birth, the infant has a natural
immunity to cot death. This may be
because of a natural gasping reflex,
which gets the baby breathing when in
danger of suffocation . The reflex is lost
after a few weeks, however, as the higher
brain takes over and begins to control the
child's development. As this happens,
the baby "re-engages" with the mother,
becoming more dependent on her. The
child is vulnerable to errors in brain-
controlled functions (such as breathing),
GUEST COLUMN
especially during the shifts from reflexive
behaviour to controlled behaviour.
One of the most important changes a
human baby has to make is in the way it
breathes, in order to vocalize speech .
The baby has to learn how to make
purposeful, non-crying noises before he
can learn languages. In the first year of
life, his breathing slows from 87 to
around 47 breaths per minute. And
between two and four months, the time
when a baby is changing his breathing
patterns, he is at his most succeptible to
SIDS . He is also most responsive at this
time to the benefits of touch.
Dr. McKenna works on the theory that
if a baby is stimulated to breathe by
movement of the womb, then a newborn
child will be similarly stimulated by the
parent at his side. We really are a
carrying species; and the infant expects
to be always with his mother or guardian .
McKenna demonstrates that ves-
tibular stimulation (e.g . breathing move-
ments of the adult's chest when asleep),
rocking, touch and heat exchange all
help to promote the health and easy
breathing of the infant . Gas exchange
may also be an important factor. The
baby sleeping next to his parents is likely
to breathe in carbon dioxide, a chemical
stimulant to take the next breath . ". . . the
infant's upper nasal chemo-receptors
may receive enough of its parent's CO; to
increase the chance of a brain stem-
inspired inspiration," he writes .
Dr McKenna does not present co-
sleeping of baby and parents as a
complete solution to cot death, any more
than solitary sleeping is the cause of it .
But he says that the baby's dependence
on his mother is a compelling reason for
not separating them at night.
Until further studies are made, we can
only speculate on the nature and im-
plications of complementary breathing.
A full understanding could revolutionize
our view of the relationship between
mother and baby, and change our
assumptions about the level of independ-
ence an infant can tolerate. Making our
babies sleep alone at night is a risk we
perhaps cannot afford to take.
Three in a Bed (Bloomsbury), is now
available for C5.99.

TREAT BONE DISEASE WITH
HRT, SAY DRUG FIRMS
Doctors, "ignorant" about the bone
disease osteoporosis which is common in
older women, are being "educated" by
the Office of I-Iealth Economics. Unfor-
tunately, the ignorance doesn't end at the
surgery door.
The ()111 :, despite its government-
sounding name, is in fact sponsored by
teh pharmaceutical industry . It has
produced a report that not only enlight-
ens doctors about the disease, but also
goes on to recommend hormone re-
placement therapy (IIRT).
I IR f, savs the report, is one of the
most eflcctive ways of treating osteorosis .
It does admit to some "concern" about a
possible link between IIRT and cancer
(if the breast and endometrium, the
womh lining, but claims the benefits far
outweigh the risks.
I lowever, the health Research Group
in the I'S has concluded that "only for
women in the high-risk group may the
henefits of estrogen (used in I]IRT) in
preventing osteoporosis outweigh the
,:on,sidcrablc risks of taking the drug".
The Health Research Group found
that the use of estrogens increases the
risk o1 endometrial cancer by six to eight
times. And women who take the drug
during menopause increase the risk of
breast cancer by So per cent, concluded
HELP GPs - LIVE IN A SLUM
About 2000 patients have so far been
struck off their (;P's books because they
arc either "uneconomic" to treat or
because they live text far away from the
surgery.
The Labour Partv has launched an
investigation into the extent of the
problem after a two-year-old heart pa-
tient was struck off by her doctor. Elis
action was later condemned by health
minister Kenneth ( ;large .
While the Labour Party is using the
material to blame the situation on the
NITS reforms, Dr James I,e Fanu be-
lieves it is nothing of the sort . Writing in
the new Independent on Sunday, he
claims that doctors are merely exercising
a bit of clout on time-wasters and
shirkers . With friends like that, GPs . . .
the National Cancer Institute of the US, a
view shared by research groups in other
countries.
But not only did the OHE researchers
overlook those findings - or, rather,
choose to downplay them - they also
ignored even more recent research
reported in the New England Journal of
Medicine last December . A study team
discovered that women were less likely to
suffer from osteoporosis if they took 220
International Units of Vitamin I) a day.
Osteoporosis is a major problem in
older women . Up to one in four who are
over 6o and one in two women in their
70s will suffer an osteoporotic fracture,
although a recent survey revealed 20 per
cent of British (;Ps had never identified a
single case among their patients .
As WDDTY reported, most British
women are reluctant to take drugs to treat
symptoms of the menopause, let alone as
a preventative measure.
The disease is both preventable
through education and treatment, the
Ofi11 report says. Though educating
doctors to treat the sufferer with I-IRT
- and so expose her to a possible
cancer-causing agent - hardly seems the
way to go .
But then, of course, Vitamin 1) isn't a
drug, is it .
An equally insightful piece comes
from another new Sunday arrival, the
Sunday Correspondent. Its medical writ-
er suggests ways the patient can help his
GP once the new fee-paying NHS
reforms arc introduced next January.
For a start, don't call your doctor out
at 9.sspm . Leave it until after topm and
he collects £45 . In the meantime, grand-
ma could tighten the tourniquet .
Give your child all the vaccinations
going (see the first issues of WDI)TY for
the risks of one of them) and it will help
your GP towards a f6oo cash bonus.
But possibly the best thing you can
do is to move into a slum . (;Ps with
an average of 2000 patients in a depri-
ved area win a jackpot D7,000 extra a
year.
NEWS IN BRIEF
* HEADLINE OF THE MONTH
UNBORN BABY WANTED BY DOC-
TORS FOR MIRACLE OP
Sunday Times, 4 February
WOMB OPERATION BABY DIES IN
MOTHER'S ARMS
Sunday Times, it February
Men who have had vasectomies may
face a higher risk of cancer of the testes,
according to a study carried out in
Edinburgh and Bangour, West Lothian.
The study group, which reported their
findings in the British Medical Journal,
found testicular cancer in S of the 3,079
men with vasectomies examined, or four
times the number they expected .
This coincided with other studies
showing an increase incidence in tes-
ticular cancer, although they had been
explained by cancers existing before the
time of the vasectomies .
Mr Alexander Cale and his colleagues
at Bangour General Hospital also say that
tumours may already have started to
develop before the procedure - a pro-
cess accelerated by the operation .
Nevertheless, he called for a large study
to confirm their findings, particularly
since vasectomy is gaining in popularity
as a permanent form of birth control.
* The Good News is . . . Department :
Iligh-factor sun screens products may-
block out one kind of cancer causing ray.
Byt they may let through others which
may bring on wrinkles, premature aging
and skin cancer, according to one of Bri-
tain's top authorities on photobiology .
Dr Brian Diffey, who heads the medical
physics unit at Dryburn Hospital in Dur-
ham, says that skin creams with a factor of
Sl'1 ; (Sun Protection Factor) of to or more
may be harmful when sunbathing bcause,
while absorbing the shorter wavelength
components of the sun's ultraviolet rays
(U VB), they still allow through the longer
wavelengths, known as UVA rays. This
problem extends to sun beds, which emit
UVA rays .
Dr Diffey's hospital is reports a
marked increase in the number of
patients with "skin fragility syndrome",
mostly young women frequenting
sunbeds three and four times a week,
whose skin bruises and blisters with the
slightest knock.
Dr Diffey believes that an SPF of 4 to 6
times is adequate protection for sun-
bathers.

BIG BUCKS FOR
OLD BONES
Under the heading "Osteoporosis - a
disease whose time has come", the
Pharmaceutical Business News told its
readers that the latest commercial oppor-
tunity is afforded by the interest in
osteoporosis among women's groups and
even scientists attending a recent confer-
ence on the subject. "Osteoporosis
represents an excellent therapeutic niche
for the drug with the affected population
increasing in numbers, living longer and
requiring drug therapy from the age of 50
at least 20 years," said the report.
Small wonder, then, that drug com-
panies all over the world are falling over
themselves, diving into research and
experimenting with a wide variety of
cures . "What is surprising is that is has
taken the drug industry so long to
discover the disease," says the PBN.
Traditionally the domain of hormone
therapy (see opposite page for possible
side effects), companies are now trying
out such things as biphosphonate com-
pounds, used mainly to treat Paget's
disease and hypercalcaemia-linked mal-
ignancies. They are also looking to the
use of calcitonin, a hormone from the
thyroid which lowers the body's calcium
levels . The problem with calcitonin,
however, is that you have to administer it
in the muscles or under the skin, which is
why most patients turn off the treatment.
The most novel (and PBN claims,
promising) development is a nasal spray
form of calcitonin, now produced by
Sandoz in Italy. Despite enthusiastic take
up by the Italian women, the PNB quotes
one Dr D Taylor of ICI, who worries that
such nasal sprays, "with absorption
promoters will cause side effects" . -
Pharmaceutical Business News, 16 Feb-
ruary, 1990
The latest bizarre side effect of the
benzodiazepines (the tranquilizers and
sleeping pills like Valium) is their ability
to cause sexual fantasies . Some 42 cases
have been reported of women sedated
with a benzodiazepine for a dental
operation accusing their dentist of sexual
assault while they were under the drug.
The most public case of this was in
1986, when a Canadian patient accused
her doctor of putting her hand on his
privates while she was recovering from
benzodiazepine, given intravenously in
the hospital emergency room . The wom-
an took him to court. The doctor's
defence - that he was simply ask her to
squeeze two fingers of his hand to test her
ability to respond to command - pre-
vailed and he was acquitted and the
verdict upheld on appeal . Nevertheless
he has been charged by the Canadian
College of Physicians and Surgeons with
disgraceful and unprofessional conduct
and has lost his license to practice . - The
Lancet, 20 January 1990)
This latest report is at variance with a
column written by Dr James Le Fanu in
the first issue of the Independent on
Sunday, intended as an apologia to
Valium . "You're not starting me on
those, I'll never get off them," is quoted
as a patient's usual response to a Valium
prescription, "as if," says Dr . Le Fanu,
scratching his head, "this safe and
effective drug commonly leads to addic-
tion ." Dr Le Fanu believes that you can't
prove that Valium is addictive because
the symptoms of withdrawal are often
identical to those the drug is supposed to
have treated. And besides which, accord-
ing to one report he cites, at least taking
Valium is better than drinking too much .
As many as one-third of surgical patients
and accident victims are dying at the
hands of inexperienced junior doctors
carrying too much responsibility out of
hours, according to two ill-publicized
reports prepared by the Royal College of
Surgeons and other associations.
The Association of Anaesthetists and
the Association of Surgeons, examining
why patients in three NHS districts died
after surgery in 1986, concluded that the
surgeon was in some way to blame in
about 30 per cent of cases and that junior
doctors were inappropriately involved in
half of these.
In one-third of all emergency cases,
the surgeon was no more than a fifth-year
trainee without a supervising consultant .
Many junior staff performed surgery
"without prior consultation with the
consultant surgeon in charge," said the
report. "Many operations were under-
taken by surgeons too junior and too
inexperienced to do the job," leading to
frequent mistakes . Fatique was a possible
factor in 26 deaths.
Another report in late 1988 by the
Royal College of Surgeons studying looo
fatal accident victims estimated that one
in three of the victims died needlessly as
a result of being cared for relatively
inexperienced staff. Eight-six out of 170
patients died because they were wrongly
diagnosed; others died from internal
bleeding because the junior in charge
didn't know the correct procedures . The
report also suggests that those surgery
patients with a better than 50 per cent
chance of survival died because they
were operated on by junior surgeons .
A study of 149 patients with dyspepsia
(pain, discomfort or burning in the
middle or upper portion of the stomach
or lower chest) concluded that the use of
non-steroidal anti-inflammatory drugs
(NSAIDs), commonly used for arthritis,
tend to mask early signs of life-threaten-
ing peptic ulcerations, often used by the
drug. The researchers concluded : "From
our evidence all patients taking non-
steroidal anti-inflammatory drugs must
be assumed to be at risk of developing
peptic ulceration, with the consequent
risk of bleeding or perforation, irrespec-
tive of either the presence of or the
characteristics of dyspepsia. Non-
steroidal anti-inflammatory drugs
should be avoided whenever possible . . ."
- The British Medical journal, to
February 1990 .
In an article entitled the Immunologi-
cal Complications of Transfusion,"
Marcela Contreras, director of the North
London Blood Transfusion Centre, says
that most incompatible transfusions are
caused by giving blood to the "wrong"
patient, ie, someone other than the one
whose blood serum was tested before the
transfusion. Although the frequency of
this happening is unknown and probably
underreported, she says that published
reports estimate the mix-up happens as
much as one in every thousand cases. -
The British Medical journal, 20 January
1990 .

I am particularly interest-
ed in Dr Patrick King-
sley's dietary advice about
multiple sclerosis. -
S.M .S., Norwich
Dr Kingsley, who has spe-
cialized in the treatment of
MS victims through a com-
prehensive, non-drug approach, claims
to have helped more than 6o per cent of
his patients - some looo people - to get
better . We asked Dr Kingsley to outline
his approach :
"The following suggestions are, by
their nature, very general, as any pro-
gramme must be designed individually .
Although diet is only one part of
treatment, as with all complementary,
non-drug approaches, it is of course
important. In my experience, it's worth-
while avoiding a number of foods . I
would place milk products at the top of
the list, along with tannin, caffeine and
citrus fruits . Other foods to avoid include
the nightshade group - potatoes, toma-
toes, aubergines and peppers. Sur-
prisingly, only about five per cent of my
patients appear to be gluten sensitive;
since many books on MS extol the virtues
of a gluten-free diet it may be that I'm
missing something here.
. "By the time I see patients they also
tend to have a problem with candidiasis,
although we don't know whether the
candida has any relation to the develop-
ment of MS or whether it is just an inevi-
table outcome of a compromised immune
system or too many antibiotics. I usually
treat the candida with a yeast-free,
anti-candida, low carbohydrate diet .
"Nearly every single MS patient I've
treated has had an excessively high level
of mercury. This was confirmed scientif-
ically in the March 1989 issue of the
Swedish Journal of Biological Medicine,
which published a study showing that the
normal mercury level in the spinal fluid
contained 0.4 ug per liter; in the MS
victims studied, that level rose to an
average of 3.0 ug per liter. I test patients
for mercury sensitivity; and if they test
positive I suggest that they get the
almagam fillings in their teeth replaced,
the most likely source of the toxic metal.
However, it is very important that the
intended replacements be tested to make
sure the person does not react. It is also
important that the patient be protected
QUESTIONS FROM READERS
from the effects of the mercury being
released into the body when the fillings
are removed. I usually prescribe
selenium, zinc and possibly vitamin C.
"My experience has been that MS
patients almost invariably have a B1z
deficiency, which I confirm by clinical
diagnosis; the current routine blood tests
for B1a levels have been shown to be of
limited value by the neurology depart-
ment at Kings College Hospital .
"Finally I find that exercise is very
important for those people whose illness
is primarily a motor deficiency, not a
sensory one (ie, they experience pins and
needles)."
I've had some terrible ex-
periences, especially with
gynaecologists . Just re-
cently I had to undergo a
biopsy and while giving it to me, the
doctor wounded me. I got an infection
and I spent two weeks in bed!
But what happened to me is years ago
is even worse. I had surgery (not
hysterectomy) for endometriosis. After
that I was given Depo-Provera injections
to stop my periods for six months. I was
wearing contact lenses . The hormone
changes brought about by Depo-Provera
caused a slight change in the curve of my
corneas. As a result of this the contact
lenses scratched my corneas, and I had to
have bilateral corneal transplants! - M.
D-L, Malibu, Calif
We're not surprised you
had problems with the
biopsy ; see this month's
cover story for other problems associated
with procedures that remove a portion of
the cervix.
What we are surprised about, how-
ever, is that the doctor prescribing
Depo-Provera didn't ask whether you
wear contact lenses, as the drug's effect
upon the eyes is well documented. In
fact, Upjohn, its manufacturer, now
advises physicians to be alert for any
changes in the eye with a view to stopping
the medication immediately .
Depo-Provera, or medroxy-proges-
terone, as it known generically, is a
progestogen, a synthetic preparation of
the female hormone progesterone. That
powerful hormone governs the changes
in the lining of the uterus during the final
half of the menstrual cycle, and stops
ovulation and develops the placenta
during pregnancy. The synthetic variety
like Depo-Provera is prescribed to treat
irregular periods or failure to men-
struate, endometriosis and uterine
bleeding . Doctors often try to treat
painful periods by stopping ovulation
with oral contraceptives containing a
progestogen . Increasingly, synthetic pro-
gesterone is also offered to older women
taking estrogen replacement therapy, to
treat the problems of menopause or
osteoporosis. This is because estrogen
thickens the lining of the uterus . The
progesterone is supposed to reduce this
thickening and also to prevent en-
dometrial cancer, which can be caused
by the estrogen . Depo-Provera is oc-
casionally used to treat kidney and breast
cancer.
America's Health Research Group
lists the following side effects associated
with synthetic progesterones: bulging
eyes, double vision or loss of vision,
blindness, blood clots, strokes, persistent
or abnormal vaginal bleeding, slurred
speech, pains in chest and elsewhere,
breast lumps, mental depression, severe
headaches and shortness of breath . It is
also known to cause birth defects and to
affect many organs of the body .
Although it used to be given in the first
trimester of pregnancy in an attempt to
prevent recurrent miscarriages, Depo-
Provera's manufacturer, Upjohn, now
publishes a large WARNING in its
listing in the American Phvsician's Desk
Reference, the US equivalent of The
Datasheet Compendium, the doctor's
handbook of drugs uses and side effects .
The warning states : There is no adequate
evidence that such use is effective and
there is evidence of potential harm to the
fetus when such drugs are given during
the first four months of pregnancy . . .
Several reports suggest an association
between intra-uterine exposure to
female sex hormones and congenital
anomalies, including congenital heart
defects and limb reduction defects. One
study estimated a 4.7 fold increased risk
of limb reduction defects in infants
exposed in utero to sex hormones (oral
contraceptives, hormone withdrawal
tests for pregnancy, or attempted treat-
ment for threatened abortion). Some
of these exposures were very short
and involved only a few days of
treatment.
 Among nearly two columns of pos-
sible side effects in tiny print Upjohn also
cautions : "Discontinue medication pend-
ing examination if there is sudden, partial
or complete loss of vision . . .Ifexamination
reveals palilledema (swelling) or retinal
vascular lesions, medication should be
withdrawn." Upjohn also reports in
long-term animal studies that both bea-
gles and monkeys receiving doses for 9o
days developed breast or uterine cancer .
Besides impaired liver function and a
four-fold increase in the risk of throm-
botic disease (ie, strokes), this drug can
cause you to lose your periods or be
infertile for up to t8 months. Interesting-
ly, the manufacturer's warning is far
more modest on this side of the Atlantic
in The Datasheet Compendium.
While we cannot offer any assistance
for your suffering at the hands of doctors
in the past, we can only suggest that the
next time someone suggests a surgical or
pharmaceutical approach to a gynecolo-
gical problem that you study the side
effects of the powerful agents or treat-
ments being contemplated before sub-
jecting your body to them . And for all
other readers we would strongly recom-
mend that you think very carefully
before taking this drug .
The Health Scandal by well known British
medical critic, author and columnist Ver-
non Coleman is now available in paper-
back by Mandarin . However, as a special
offer to WDDTY readers, we are able to
offer the hardcover version of the book at
£4 .99, the same price of the paperback, a
saving of £8 over its £12.99 cover price.
Exposing many unnecessary or dan-
gerous drugs and procedures in both
traditional and alternative medicine,
Coleman makes a convincing argument
that most medicine is bad for your health .
If you would like your hardback copy at
the special rate, send a cheque made out
to The Health Scandal for £5.49, which
includes 5op postage to WDDTY at our
address, and we will send on the cheque
to Dr Coleman's agents .
AUTHOR : Belinda Barnes and Suzanne
Gail Bradley
TITLE: Planning for a Health Baby
PUBLISHER: Ebury Press
PRICE: £6 .95
Subtitled "Essential reading for all future
parents", this outlines the programme of
Foresight: The Association for the Pro-
motion of Preconceptual Care . Founder
and co-author Belinda Barnes operates
her charitable organization on the pre-
mise that infertility, problems of preg-
nancy and birth defects are largely
caused by dietary and environmental
factors. Many couples can eliminate
these problems by following a pro-
gramme of "preconception" care months
before they plan to conceive .
The authors provide convincing evi-
dence of the role of negative influences
on pre-natal health, primarily vitamin or
mineral deficiencies, and excess toxic
metals such as lead or mercury on birth
defects. Particularly enlightening is their
research on the role of zinc and mag-
nesium on infertility and low birth
weight babies . They also offer indispen-
sible advice on the sort of diet and
supplementation programme that will
boost your health before, during and
after pregnancy.
Mrs. Barnes' "proof" of her success is
the scores of case studies she enumerates
of formerly infertile couples or those with
a history of miscarriage who follow her
programme and go on the produce
healthy, good sized babies .
Advisory Board
Send us your most pressing medical questions. While we regret we cannot
reply to your queries personally or on the telephone we are happy to put
your questions to the appropriate doctor or organization on our panel and
publish his or her suggestions in future issues. The views expressed in this
publication are not necessarily those of the editorial panel.
Dr Leo Gafand
Dr Michel Odent
Dr Jean Monro
Dr Patrick Kingsley
DrJ. R. Mansfield
Dr Kai Kermaia
Dr Alan Franklin
Dr Belinda Bastes
Dr Vieky Rippere
Dr M. J. Radclife
Dr J. Anthony M
Tony Newbury
Jack Levenson
AUTHOR: Dr Jonathan Brostoff and
Linda Gamlin
TITLE: Food Allergy and Intolerance
PUBLISHER: Bloomsbury Press
PRICE: £.4.99
This is an everything-you-ever-
needed-to-know-about-allergies type
book . Brostoff and Gamlin don't shy
away from examining the controversy
and various bones of contention among
medics today about allergies, including
the far too common assumption that the
problem (like candidiasis) is all in your
mind or that there is no %xorkablc
treatment for it and vou'll just have to
learn to live with it .
Brostoff, for one, believes that aller-
gies can be both diagnosed and treated.
He advocates diagnosis through MAST
allergy screening, now used at Middlesex
Hospital, which pinpoints a patients
sensitivity to his environment, say, syn-
thetics or pets . The book elaborates his
"staving well" programme, which in-
cludes standard elimination and rotation
diets, sometimes combined with desen-
sitization techniques, which entail being
injected with the offending substance in
minute doses until one builds up a
temporary tolerance to it. Although we
quibble with some of Brostoff's advice,
such as maintaining hyperactive children
on d-ugs while investigating whether the
problem is food allergy, his book is well
set out and easy to dip into for quick
reference.
Amanda Hibbs
Annentarie Colbin
Dr Helen Dziemidko
Dr Andrew Strigner
Clio Pinkney
The Doctor's People
Foresight
La Leche League Great Bri
(breastfeeding advice)
Active Birth Centre
The Hyperactive Child
Support Group
National Society for
Research into Allergy
 SECOND OPINION

The marketin of medicine

oday the drugs industry has a
very tight hold over the medi-
cal profession . Most practising
doctors get most or all of their
postgraduate education from sources
sponsored or paid for directly by the
drugs industry. The British Medical
Association receives hundreds of thou-
sands of pounds every year from the
drugs industry . And thousands of in-
dividual doctors allow themselves to be
"bought" by companies aggressively
pushing new products .
The drugs industry has even reached
into the heart of the medical establish-
ment - the General Medical Council -
and members of the Council (which re-
gulates disciplinary procedures within
the medical profession) have admitted
that they receive large sums of money from
drug companies for research and for ex-
pensive overseas trips.
Even the Royal College of General
Practitioners, which represents the spe-
cific academic and professional interests
of Britain's general practitioners, has
created an organization called the Medi-
cal Surveillance Organization which
exists to help organize and run drugs
surveillance projects for drug companies.
In 1984 NISO, hired by Hoffman-La
Roche m research a new benzodiazepine
tranquillizer and by another company to
investigate a ne%y relatively untried
painkiller, offered participating doctors a
f,6o to £7o fee. In another drug trial, Dr
Clifford Kay, one of the directors of the
MSO, admitted that MSO was probably
Britain spends aroun £Zoo million on
selling its drugs to doctors. That means
that each year the drug companies spend
around £5,ooo persuading each family
doctor to prescribe their products . They
give him free gifts, they send him free
magazines, they take him out to lunch (I
know of GI's who haven't paid for a meal
in a restaurant for years), they bombard
him with leaflets, and they pay for him to
go abroad to "conferences" (which are,
`Drug companies
spend X5 .000
persuading each
family doctor to
prescribe their
products .'
oddly enough, always held in exotic
places like Miami or Hong Kong . They
rarely hold conferences in Manchester or
Reading) . Most of the drug company
representatives who promote drug ; to
doctors (and who are, therefore directly
responsible for "educating" doctors in
Britain) have no official medical training
at all. hhev are merely indoctrinated with
basic information about a small number
of drugs and then encouraged to pass that
mation about new drugs and on teaching
doctors about the problems and side
effects associated with modern treat-
ments. And the average doctor probably
spends about £5 a year on his own
education. One new textbook every five
years is probably an over-optimistic
estimate of the average GP's commit-
ment to self-improvement . It is an
alarming thought that most of the doctors
in practice today qualified before the
contraceptive pill was generally available
and completed their training in pre-
Valium times. Most of the drugs GPs
prescribe have been introduced since
they qualified and information about
new ones arrives through the letter box
every day. A doctor who is now 50 will
have qualified before oral contraception,
heart, liver, kidney or lung transplanta-
tion, and tranquilizing drugs were
introduced . He will have qualified before
at least go per cent of the drugs he
prescribes were introduced . And he will
have qualified before drug side effects
and hazards were widely recognized .
It is hardly surprising that the majority
of doctors in practice today are badly
informed and uncritical . It is difficult to
see how a profession that takes its
instructions from a trade can continue to
call itself a profession . Or to put it
another ttiay, if lawyers allowed burglars
to make our laws, then I suspect that our
respect for the legal profession would
reach a nets lmy.
Vernon Coleman
I croon Coleman is author of the Health

wrong in offering to pay GPs £6 per information on to the doctors they meet. Scandal . See page 7 ./or special offer on his
patient to provide reports. In contrast, the NHS spends about £70 hardback edition, available exclusivch, to
Every year the drugs industry in per doctor per year on providing infor- WDDTY readers.

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