Friday, December 31, 2010

Zippity Zappity, Powerbands and AMI

I thought that I would make my last post for 2010 a recap of the fight against quackery and shonky medicine in Australia. The ACCC and TGA seem to be finally growing some balls because we have seen public action against Fatzap, Power Balance Bands, and now AMI. So far, AMI has filed for liquidation, Power Balance's Tom O'Dowd has admitted that his claims are rubbish, but FatZap is still standing.

Power Bands

For those not familiar with the story of the Power Balance Bands, these are small silicone bands bearing holograms that would allegedly improve your concentration, energy, performance or whatever. Frankly, this is a whole load of bullshit and there was no way that they could physiologically work, but that didn't stop a whole series of paid sporting celebrities wearing them and effectively promoting them.

The company claims (via its US website, as the Australian website has been ordered to take down these claims):

Power Balance is Performance Technology designed to work with your body’s natural energy field. Founded by athletes, Power Balance is a favorite among elite athletes for whom balance, strength and flexibility are important.
Power Balance is based on the idea of optimizing the body’s natural energy flow, similar to concepts behind many Eastern philosophies. The hologram in Power Balance is designed to resonate with and respond to the natural energy field of the body.

The NineMSN report (below) of copycat competitor Eken Power Bands makes very similar claims. Notice how despite having a series of experts saying it is rubbish, they still add in an upbeat soundtrack, fall for some nonsensical "tests" which are clearly admitted to be nonscientific and easily manipulated, and suggest that a "placebo effect" (which is basically when a subject thinks a treatment is working even when it isn't) is a good thing, and still a good reason to waste money on a $60 elastic band on the wrist. What next? Magical staples? Psychic paperclips?

The Power Balance guys say that you can test that the band is working and help spot "fakes." Obviously, this is a rigorous and high-tech process as the following image shows.

Personally, I'd prefer to trust the tests done by Choice Magazine and Australian Skeptics, which clearly prove that these devices are ineffective and that the ACCC is justified in forcing Power Balance to withdraw their claims and offer a full refund to all customers.

"We'd made claims in the start that said that our product improved strength, balance and flexibility," he told the ABC's AM program.
"And we didn't have the scientific peer-reviewed double blind testing or the level of proof that we needed to substantiate those claims."
- Tom O'Dowd, Power Balance CEO. ABC Radio AM - 23/12/2010

"Advanced" Medical Institute

One of AMI's controversial billboards.

As for AMI, or Advanced Medical Institute, a sister-company to my much-favoured Heart-Check Clinics (see Heart Check? Blank Cheque! and Part 2), they have had a series of devastating blows in the UK and Australia. This is the company responsible for those horrible billboards and TV advertisements (above) promoting treatment for erectile dysfunction (and inviting every form of sexual innuendo and pun available). This effectively rides on the coat-tails of big-budget pharmaceutical promotion for Viagra, and offers a series of expensive, escalating treatments ranging from nasal sprays to penile injections - all in direct competition to that blue pill.

There is no doubt that AMI has been very successful, and despite being under the spotlight for many years, it has managed to continue raking in the cash and staying in business. Why? Well, Jack Vaisman, founder of AMI has managed to find a little niche by:
    AMI Founder Jack Vaisman
  • utilising a growing market and consumer demand fostered by other parties (such as Pfizer)
  • making use of a sensitive and embarrassing topic (impotence or erectile dysfunction), with many patients unwilling to air their dissatisfaction in public or approach authorities
  • boldly pushing ahead with mass advertising, successfully made them a household name
  • advertising a plausible, publicly tolerable (apomorphine nasal spray) treatment with minimal further detail, and then sucking consumers into overpriced conventional erectile dysfunction therapy using typical bait-and-switch sales techniques
  • locking customers into expensive, 6-month "contract sales" where they pay a large fee (either lump sum or monthly) for a supply of the aforementioned spray, with the only means of backing out being to complete a series of conventional but increasingly undesirable therapies (such as Papaverine or Prostaglandin Penile Injections) - like mobile phone companies and their contracts

Whilst it is good to see that authorities have finally done enough to cause Jack Vaisman to liquidate AMI, the most disturbing thing is that it does not really address the heart of his success - the ability to make unsubstantiated and fraudulent claims about his treatments. It is not the TGA that has been successful as exposing him as a shonk and shutting him down - it is the ACCC which has fined him for unconscionable sales conduct, and allowing non-medical staff to provide medical services and advice. To me, it highlights the impotence of the TGA at regulating the claims of therapies in its register, which is much more serious than the impotence of AMI's customers. It also demonstrates the lack of moral and ethical behaviour amongst unregistered, pseudomedical practitioners who fall outside any effective professional regulatory framework.


Which leads us to FatZap. This company claims that by applying heat (via infrared laser, ultrasound, radiofrequency or whatever) to an area of subcutaneous fat that it can just make it go away.

Fatzap™ Ultra Sound Treatment uses low frequency ultrasound resonance technology to disrupt fat cells. An ultrasound beam selectively targets fat cells in the chosen body area, and brings them to self resonance. This process triggers the fat cells to release their fatty substance in that particular area. The fat cell content, primarily comprised of triglycerides, is dispersed into the fluid between the cells and then transported through the vascular and lymphatic systems to the liver. The liver makes no distinction between fat coming from the Fatzap™ treatment and fat originating from consumed food. Both are processed by the body’s natural mechanisms. So that your body metabolises this excess liquefied fat rather than stores it elsewhere in the body, we recommend a low carbohydrate eating plan with overall negative calorie intake for several days following each treatment.

Personally, I don't want ultrasound to damage any of my cells, be they fat or otherwise. Did you know that the myelin sheath around your nerves is composed of 80% fat? If FatZap's claims are true, I'm waiting for an explosion in legal suits for peripheral neuropathy.

Like many cosmetic clinics, FatZap pushes its products through social media seeding - where someone posing as a satisfied customer makes comments on community forums or blogs saying how great the treatment is - a cheap and nasty way to make unsubstantiated claims as the comments can't be traced back to the source. Look at the following forums / chat boards for examples, and notice how the most enthusiastic comments are from new members with only 1 post.
Walking Adipose from Partners in Crime,
Doctor Who (BBC 2008, Episode 1, Series 4)

Personally, I would have thought that these treatments are about as realistic as this episode of Doctor Who, but then again, some people will believe anything. Let's hope that FatZap and its copycats don't last beyond 2011.


Power Bands Let Loose
  • Watchdog says power wristbands a crock - ABC News Australia Dec 2010
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  • Power band no better than a rubber band: ACCC - The Australian Dec 2010
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  • Do power bands really work? - NineMSN Sep 2010
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  • Power of holograms or just a big scam? - Sunday Mail Apr 2010
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AMI Deflated
  • Sex ripoff 'unconscionable' - SMH Dec 2010
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  • The hard sell for longer-lasting sex - SMH Dec 2010
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  • ACCC alleges unconscionable conduct in promotion and supply of men's sexual dysfunction treatment program - ACCC Website Dec 2010
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  • London clinic’s £3,000 ‘cure’ for impotence was only a nasal spray - London Evening Standard Jul 2010
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  • Advanced Medical Institute to pay compo - SMH 7 Dec 2010
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  • Doctors give sex drugs a spray - SMH May 2009
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  • Want longer lasting sex? Steer clear of AMI’s ‘Nasal Delivery Technology’ - Feb 2009
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  • The controversial life and times of Doctor Droop - The Age Feb 2009
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  • Rise of nasal spray guru - Daily Telegraph Oct 2006
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FatZap Not the Good Oil
  • Fat zappers may be a fad too far - The Age Sep 2010
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  • Fatzap Centres continue to claim to melt away weight - Herald Sun Aug 2009
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Wednesday, September 01, 2010

Who needs a stethoscope?

I posted an entry some time ago about the move to digital stethoscopes under "Listen to me..."

Now I see that we can dispose of the stethoscope and just use our iPhones.

This is one app that I am definitely not purchasing.

I used to have a consultant physician who taught me that "The most important part of a stethoscope is the bit between the earpieces."

Sage advice.

iPhone set to replace the stethoscope - The Guardian
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Tuesday, August 17, 2010

e-Health, Telemedicine, and Elections

HP and Dreamworks' Halo Videoconferencing Solution.
Completely unnecessary for doctors, but it sure looks cool.
I love e-things. I am a gadgety sort of person – and yes, I do have a fancy super-duper iPaddy kind of thing. I consider myself to be techno-savvy, and run my private practice with an almost paperless electronic records system. I am an early adopter of many technologies, and will always try new things. But I am not so convinced on e-Health. Why?

e-Health is all the rage. The federal government even has a special taskforce called NEHTA (National e-Health Transition Agency) which is dedicated to wasting investing money in this area. It is all about "transforming and revolutionising" the way we practice medicine.

I don't want to transform and revolutionise anything. I just want to be able to treat my patients better and more easily. This does not require me to have access to every piece of medical documentation on a patient since they were born. It does not require me to be able to access a full medication list and prescribe remotely to a patient on the other side of the country. It also does not require me to videoconference with every patient or doctor in the country.

We have many, many technologies today which make things easier. Often they are the simplest things, and usually they are so pervasive and useful that we take them for granted, like the telephone.

Now, it would be remiss of me not to point out that we are in the latter half of a Federal Election campaign here in Australia. What prompts this post is not the lack of comprehensive health-care policy discussion from either major political party so far, nor the incessant, disproportionate focus on mental health whenever any health funding is mentioned. Julia Gillard's health policy is "Doctors are expensive so let's replace them with technology, physician assistants, nurse practitioners and allied health." Tony Abbott's health policy is "It's too hard let's just hand it to local communities."

But it does bug me that Julia Gillard can stand up and say that she will fund a revolutionary new "Online Consultation" service with a new Medicare Item Number. This is a government whose Health Minister, Nicola Roxon, has been trying very hard to slash item numbers such as those for Cataract Surgery, Obstetric Services, Coronary Angiography, Joint Injection, and Injection Sclerotherapy for Varicose Veins (MBS Website). There is no doubt that this is merely an "election sweetener" for rural GPs and rural voters, and those employed in the technology infrastructure sector.

Steady uptake in Telepsychiatry.
An item number already exists for Telepsychiatry consultations (Items 353-370), and uptake has been gradual - pushed primarily by a small number of psychiatry groups. One might think that psychiatric consults are ideal for videoconference but remember that a great deal of patient interaction is via non-verbal communication and behavioural cues, which even videoconferencing cannot replicate. The RANZCP has guidelines as to how they recommend Telepsychiatry be used.

But much as videoconferencing might be the poster-boy of this type of technology, it ignores the fact that there are many simpler and commoner means by which clinical information is communicated between patients, GPs and specialists, such as email and the telephone.

For example, this policy announcement outlines a scenario whereby a patient might conduct a combined GP visit with an online videoconference to an oncologist. Presumably this is encouraged by the GP and the Oncologist both being able to claim an item number for this consultation.

The key parts of this conference are that first of all, the patient knows that the oncologist exists and is not a figment of the GP's imagination (but there are other means of achieving this) and secondly, the GP is able to discuss the patient's individual treatment plan with a distant oncologist (which is best done in private away from the patient). Given that the private conference is the most important, why restrict any Medicare benefits to a combined patient-GP-specialist consultation?

Currently, patients who will not or cannot travel to see an oncologist can be cared for by a GP or local physician, with instructing care issued by a remote oncologist by much more prosaic technologies as mail, or telephone. Video-conferencing is sometimes used for multidisciplinary team meetings. Realistically, the video adds very little to such meetings or discussions, so it is silly to think that an item number must insist on the conference occurring via video-link. In that setting, should Medicare benefits be available for specialists who spend their time giving advice over the telephone, or reviewing patient files and sending a letter of advice?

If that is the case, then I should be paid Medicare benefits for all the GP queries that I get over the phone, and all the paperwork that I perform organising a patient's care in between physically seeing them. Instead of seeing review patients, I could just check their results, give them a phone call, and lodge the Medicare claim. Is that good or bad? It sure would make my job easier. I could see more patients. It would be significantly cheaper and more convenient for the patient. Even better, if the new Government were to fund practice nurses for specialists, then I could delegate the job to my nurse!

First patient to survive a stroke without side effects?
BULLSHIT! What a way to blow your own trumpet!

Why is it that when you slap a computer with the Internet on it, everything suddenly becomes "Telemedicine"? Since the telephone was introduced doctors have been giving instructions from remote. Is that "Telemedicine?" For years I have been reviewing photos of patients and their X-Rays via email from distant GPs. Am I on the cutting edge of Telemedicine? I have had remote PACS access to a number of hospitals and reviewed films from home. I have advised surgeons and GPs in other towns how to perform surgical procedures over the telephone. Should I be on the news because I am a frontier Tele-surgeon? I don't think so... this is just part of the pervasiveness of communications technology into common life, as well as medicine.

I don't know about you, but this thing
would scare the crap out of me.
My advice, Julia – scrap the "Online Consultations" rubbish and bring in an item number that pays doctors for all the organisational work involved in-between face-to-face patient visits, allow doctors to be paid for telephone consults, advice and services, and don't bother wasting money on teaching doctors to videoconference when they will use it perhaps once of twice a year just for fun. Spend the money on secure integrated email for all doctors and practices. Oh, and funding for specialist practice nurses please.