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SKEPTICAL INQUIRER ELECTRONIC DIGEST


SKEPTICAL INQUIRER ELECTRONIC DIGEST
For free Digest subscriptions, go to:
http://www.csicop.org/list/index.html#subscribe

SKEPTICAL INQUIRER ELECTRONIC DIGEST
February 3, 1999

SI Electronic Digest is the biweekly e-mail news update of the Committee for the Scientific Investigation of Claims of the Paranormal (CSICOP.) Visit http://www.csicop.org/. Rated one of the Top Ten Science Sites on the Web by HOMEPC magazine.

The Digest is written and edited by Matthew Nisbet and Barry Karr. SI Digest has over 3000 readers worldwide, and is distributed via e-mail from the Center for Inquiry-International, Amherst NY, USA.

To subscribe for free to the SI DIGEST, go to:
http://www.csicop.org/list/

PERMISSION IS GRANTED TO REPRINT OR REPOST ON THE WEB. WE ENCOURAGE TRANSLATION INTO OTHER LANGUAGES.

PLEASE FORWARD TO YOUR FRIENDS.
Send comments, media inquiries and news to:
SINISBET@aol.com (716-636-1425 x219)

CSICOP publishes the bimonthly SKEPTICAL INQUIRER, The Magazine for Science and Reason. The Jan/Feb 1999 issue features a Special Report on Armageddon and the Prophets of Doomsday.

To subscribe at the $17.95 introductory Internet price, go to:
http://www.csicop.org/si/subscribe/

In this week's SIDIGEST:

--CSICOP to Appear on The Learning Channel's "Strange Science"
--Failed Psychic Predictions Release Gains Widespread Media Attention
--CSICOP Visits Kansas State, Kansas City, St. Louis and Springfield, IL
--Joe Nickell Lecture, Book Signing, and Master's Tea at Yale University
--OPINION: Should Managed Care Cover Alternative Medicine?

CSICOP TO APPEAR ON THE LEARNING CHANNEL'S "STRANGE SCIENCE"

This week, the Learning Channel is running a series titled "Strange Science," an hour episode appearing each week night from 10-11pm EST. Check your local listings.

The series features several CSICOP fellows and consultants, notably psychologist Barry Beyerstein in "Bizarre Phenomena," and investigator Joe Nickell in "Unusual People." For those that missed the episodes earlier this week, they will be replayed Sunday afternoon from 1-6pm EST.

Reviews of the programs can be posted at http://www.csicop.org/cmi.

2/1 Monday: Bizarre Phenomena
2/2 Tuesday: Weird Places
2/3 Wednesday: Mysterious Skies
2/4 Thursday: Unusual People
2/5 Odd Sounds

2/7 Repeat of the entire series from 1-6pm

_____________________

FAILED PSYCHIC PREDICTIONS GAIN WIDESPREAD MEDIA ATTENTION

Coverage of Gene Emery's annual failed psychic predictions has been overwhelming. The summary of 1998 failed predictions has been syndicated by the L.A. Times, mentioned in an editorial in the San Fran Chronicle, highlighted by Eric Zorn in his Chicago Tribune column, and covered by many other newspapers across the country. Emery has also done over two dozen radio interviews with the media requests continuing to pour in.

All this probably pales in comparison to coverage of next year's "End of the Millenium Failed Psychic Predictions" that Emery hopes to release in the fall. Stay tuned.

CSICOP VISITS KSU, KANSAS CITY, ST. LOUIS AND SPRINGFIELD, IL

CSICOP Public Relations Director Matt Nisbet will be touring parts of the Midwest February 11-15. He'll be meeting with college students, members of local skeptics groups and the local media. At several venues he will be giving a presentation titled "Skeptics Versus The X-Files: The Media and the Paranormal." Using video clips and slides, Nisbet reviews how the media portrays science and the paranormal, tackles the immensely popular series The X-Files, highlights research linking media presentations of the paranormal and viewer belief and reviews efforts by CSICOP, scientists and skeptics to work for better media coverage of science and the paranormal.

--On Thursday evening, February 11, as part of the Skeptical Inquirer Lecture series offered to colleges across the U.S. and Canada, Nisbet will be presenting at Kansas State University. The talk will take place at 7pm in the Flint Hills Room of the KSU Student Union. Contact jef4219@ksu.edu for more information.

--On Saturday February 12 at 730pm, Nisbet will be at the Center for Inquiry-Midwest in Kansas City, MO. The Center is housed in the United Labor Building, 6301 Rockhill Rd, Suite 412.

--On Sunday afternoon, Nisbet will be in St. Louis to present at a meeting sponsored by the Gateway Skeptics and the Rationalist Society of St. Louis. You can catch him at 2pm at the University City Library, 6701 Delmar, University City, MO 63130.

--On Monday, he'll travel to Springfield, IL to give a presentation sponsored by the Rational Examination Association of Lincoln Land (REALL). The talk will be held at 7pm at the Lincoln Library in Springfield. Call the REALL hotline number for more information at 217-726-5354 and check out their website at www.reall.org.

Everyone is encouraged to turn out for the events in their area. It promises to be a provocative and informative presentation and a great way to find out more about the international efforts of CSICOP. For more information, call 716-636-1425 X219.

__________________

NICKELL LECTURE, BOOK SIGNING AND MASTERS TEA AT YALE UNIV.

The following is a press release put out by the newly launched Yale Skeptics Society, a student group at Yale University. It details CSICOP Senior Research Fellow Joe Nickell's visit to the campus Feb. 20-24.
__________________________________
PRESS RELEASE
FOR IMMEDIATE RELEASE
Contact:
Chris Mooney, (203) 436-1725
Lukas Halim, (203) 436-1085

"Original Ghostbuster" Visits Yale

Joe Nickell to Share Tales of his Paranormal Investigations with the Yale Community

New Haven, CT -- Joe Nickell, leading paranormal detective, will be paying a visit to Yale University later this month. Popularly known as "the modern Sherlock Holmes," "the original ghostbuster," and "the real-life Scully," Nickell has investigated all varieties of mysteries, frauds, forgeries, and hoaxes, from the crop circles in Wiltshire, England to the Shroud of Turin.

A former stage magician and private detective, Nickell serves on the Editorial Board of Skeptical Inquirer magazine, for which he writes the column "Investigative Files." The author of over fifteen books, Nickell has discussed his investigations in numerous forums, including "Larry King Live," "Oprah," the "Jerry Springer Show," "Unsolved Mysteries," "Politically Incorrect," and "NBC Dateline."

Nickell will be the guest of the newly formed Yale College Skeptics Society, Yale's Silliman College, the New England Skeptics Society, the Connecticut Humanist Association, the Yale Law School Science and Technology Society, and the Yale College Society of Humanists, Atheists, and Agnostics.

Yale Skeptics President Lukas Halim commented, "Mr. Nickell is a rare specimen -- a skeptic and detective celebrity. He blends the great legacy of Carl Sagan with that of a Sherlock Holmes."

A forensics expert, Nickell is also touring to discuss his recent book _Crime Science_, which discusses the art and science of detective work. _Crime Science_ uses examples from headline-grabbing investigations such as the O.J. Simpson case to demonstrate the importance of solid science in building criminal cases.

In _Crime Science_, Nickell and co-author John Fischer also discuss the death of Marilyn Monroe, the Lindberg kidnapping, the assassination of the Romanovs and the Atlanta child murders. They explain how police use fingerprints, fiber and DNA analysis and casts made from impressions of footprints to identify suspects.

Nickell will be in New Haven from February 20-24. On Monday, February 22 he will have lunch with the Yale Law School's Science and Technology Society at 12:30 pm, followed by a book-signing for _Crime Science_ at the Yale Bookstore at 4:00 pm (77 Broadway Avenue, in New Haven). Monday evening, he will deliver a lecture on "Investigating the Paranormal" for students, at 8:00 pm in William L. Harkness Hall, Room 119.

On Tuesday, February 23 at 4:00 pm, Dr. Nickell will give a Master's Tea at Yale's Silliman College to discuss his paranormal investigations with students.

To arrange interviews with Nickell, or for more information, contact Chris Mooney, (203) 436-1725.

_____________________________

OPINION: SHOULD MANAGED CARE COVER ALTERNATIVE MEDICINE?

CSICOP fellow Dr. Stephen Barrett is a leading expert on alternative health claims. He is the author or editor of some thirty books, a contributing editor to the Scientific Review of Alternative Medicine and editor of Nutrition Forum.

Barrett is creator and manager of the Web's leading source on alternative medicine http://www.quackwatch.com, and has just launched the Web's best source on chiropractic, http://www.chirobase.org.

Barrett is profiled in the January, 25 issue of People magazine. "Doctor No. Considering Treatments that Sound Too Good to be True? Quackbuster Stephen Barrett Has a Word for You: Don't" pg. 119. http://www.people.com

In the following commentary, Barrett tackles the important issues surrounding alternative medicine and managed care.
_____________________________________________________

Should Managed Care Companies Cover "Alternative Medicine?"
Stephen Barrett, M.D.
http://www.quackwatch.com

Should "alternative medicine" be incorporated into managed care? Should managed-care organizations be free to decide this for themselves, or should outsiders dictate what gets covered?

"Alternative medicine" has become the politically correct term for questionable practices formerly designated as health frauds and quackery. Some techniques referred to as "alternative" may be appropriately used as part of the art of patient care. Relaxation techniques and massage are examples. But procedures linked to unscientific belief systems have no place in responsible medicine -- or managed care.

Definitional Problems

The biggest problem in discussing this subject is that "alternative" has many possible meanings. The dictionary definition is a choice between mutually exclusive possibilities. Until the late 1980s, in standard medical usage, the word "alternative" referred to choices among effective treatments. In some cases they were equally effective (for example, the use of radiation or surgery for certain cancers); in others the expected outcome differed but there were reasonable tradeoffs between risks and benefits. During recent years, however, the term has been applied to a multitude of unsubstantiated methods that differ from standard (science-based) care. Jack Raso, R.D., who edits Nutrition Forum newsletter, has catalogued nearly a thousand of these.

The best way to minimize confusion is to classify alternatives as genuine, experimental, or questionable. Genuine alternatives are comparable methods that have met science-based criteria for safety and effectiveness; experimental alternatives are unproven but have a plausible rationale and are undergoing responsible investigation; and questionable "alternatives" are groundless and lack a scientifically plausible rationale.

Whether some approaches are valid depends not only on their methods but how they are used and what claims are made for them. Spinal manipulation, for example, can be useful in properly selected cases of low-back pain. But manipulating the spine once a month for "preventive maintenance" or to promote general health -- as many chiropractors recommend -- is senseless. Relaxation
techniques have a limited but acceptable role in the treatment of anxiety states. But biofeedback for "mind expansion" or meditation for "balancing life energy" are another matter.

Managed Care Implications

Although patient demand is a factor, most managed-care coverage is determined by evidence of effectiveness and cost-effectiveness. The program that Dean Ornish, M.D., developed for people with coronary heart disease illustrates how this selection process should work. Ornish's approach includes smoking cessation, stress-management techniques, daily exercise, and a 10%-fat vegetarian diet. This program is novel because its dietary fat level is half the lowest level the American Heart Association recommends for people unresponsive to less stringent cholesterol-control measures. Ornish has documented his findings in a scientific manner, using before-and-after measurements of coronary blood flow and publishing his results in peer-reviewed scientific journals. His work is sufficiently promising that Mutual of Omaha is testing whether his approach is an economical alternative to bypass surgery or angioplasty in carefully selected patients. If his program proves to be cost-effective, you can bet that third-party payers will embrace it.

Coverage can also be dictated by state or federal laws. Most states have "insurance equality laws" requiring chiropractic coverage under various circumstances. A few require coverage for acupuncture, and the state of Washington recently ordered inclusion of naturopathy and massage therapy as well. The impact of such laws depends on how much is covered, who provides it, and how the coverage is structured. Many insurance companies forced to cover chiropractic services have been displeased with the results.

Chiropractic leaders misrepresent the significance of workers' compensation studies which found that patients treated by chiropractors were more satisfied and returned to work sooner than patients treated medically. These studies did not scientifically validate what the chiropractors did and were not designed for that purpose. Although most contain data appearing to favor chiropractic, their authors did not evaluate whether the patients had comparable problems. In addition, the duration and costs of disability and time lost from work are influenced by factors other than effectiveness.

In 1995, the New England Journal of Medicine published a study comparing the cost of low-back pain treatment by family physicians, orthopedists, and chiropractors in North Carolina. The median total charges were $545 by urban chiropractors, $383 by orthopedists, $348 by rural chiropractors, $214 for rural primary-care physicians, and $169 for urban primary-care physicians. Although chiropractors charged less per visit, their treatment was costlier because they saw their patients about five times as often [1].

Additional data have been collected at the Group Health Cooperative, a staff model HMO in Madison, Wisconsin. Dan Futch, D.C., chief of chiropractic practice, has found that the patients he sees require an average of three visits per episode, considerably fewer than the average reported for chiropractors in other settings. Futch is also executive director of the National Association for Chiropractic Medicine, a small group of medically oriented chiropractors and chiropractic students who have renounced chiropractic's unscientific dogma.

Many chiropractors believe that after a painful condition resolves, patients should continue indefinitely for "maintenance care." Many also believe that every spine should be examined and adjusted monthly or weekly throughout life. No evidence exists that either of these approaches benefits patients. Managed care can limit overutilization by excluding chiropractors who practice unscientifically and setting limits on the rest. Rather than raising their standards, chiropractors are filing lawsuits and asking legislators to break down managed-care barriers.

Can Oil and Water Mix?

Dr. Futch's experience demonstrates that scientifically oriented chiropractors (a tiny minority of practitioners) can be integrated into managed care. What about acupuncturists, homeopaths, naturopaths, and unscientific chiropractors?

Acupuncture involves stimulation of the skin at designated points. Traditional practitioners claim to balance the body's "life force" by inserting needles (or using other modalities) where imaginary horizontal and vertical lines ("meridians") meet on the surface of the body. These points are said to represent various internal organs (some of which are nonexistent). Some practitioners reject the pseudoscientific trappings and postulate that pain relief occurs through mechanisms such as the production of endorphins. I do not believe that acupuncture is cost-effective for any purpose or influences the course of any organic disease.

Homeopathy is based on the notion that symptoms can be cured by taking infinitesimal amounts of substances that, in larger amounts, can produce similar symptoms in healthy people. Homeopaths also claim that the more dilute the remedy, the more powerful it is. Some "remedies" are said to be so dilute that no molecule of the original substance remains, only an "essence" that cures by bolstering the body's "vital force." I do not believe that practitioners who prescribe only placebos can fit into a science-based health-care team.

Naturopathy is based on the belief that diseases are the body's effort to purify itself and that cures result from enhancing the body's ability to heal itself. Naturopathic treatments can include "natural food" diets, vitamins, herbs, tissue minerals, cell salts, manipulation, massage, exercise, diathermy, colonic enemas, acupuncture, and homeopathy. Like some chiropractors, many naturopaths believe that virtually all diseases are within the scope of their practice. I don't see how practitioners involved in so much nonsense can fit into a science-based health-care team.

Chiropractic encompasses a broad spectrum of practices related to the false premise that spinal misalignments ("subluxations") are the cause, or underlying cause, of most ailments. Chiropractic's founder postulated that the body's "vital force," which he termed "Innate," expresses itself through the nervous system. Chiropractors who cling strictly to this notion allege that subluxations cause most illnesses by interfering with the flow of "nerve energy" to body organs. Most chiropractors acknowledge the importance of other factors in disease but tend to regard mechanical disturbances of the nervous system as an underlying cause. Many chiropractors engage in unscientific diagnostic procedures, prescribe inappropriate food supplements, and utilize homeopathic remedies. Small percentages denounce chiropractic's basic dogmas, spurn its unscientific practices, and confine their practice to musculoskeletal problems. Thus while virtually all chiropractors manipulate the spine as their primary method of treatment, their rationale and techniques vary considerably. Many homeopaths, naturopaths, and chiropractors are lukewarm or opposed to immunization.

Key Questions

Can unscientific practitioners be subjected to utilization review and other quality-control measures? Can practitioners immersed in "vital forces," "subluxations," and similar concepts provide high-quality care for their patients? Should practitioners who oppose proven preventive measures be permitted to practice within a managed-care setting? (Even worse, should they be permitted to be their own gatekeepers?) If treatments are ineffective, is there any evidence that allowing subscribers to use them will reduce the overall cost of their health care?

My answer to each of these questions is no.

Reference

1. Carey TS and others. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. New England Journal of Medicine 333:913-917, 1995.

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