Filipino Superstitions: Dra. Denise Slams Email Spam

FJ, Volume 22, Number 16
Aug 22 - Sept5, 2008

I received the following 2 emails from my parents which had been circulated among quite a few pinoys:

1) “A NEEDLE CAN SAVE THE LIFE OF A STROKE PATIENT -
From a Chinese Professor....When stroke strikes, the capillaries in the brain will gradually burst..... stay calm. No matter where the victim is, do not move him...Because, if moved, the capillaries will burst. Help the victim to sit up and then the blood letting can begin. If you have...an injection syringe that
would be the best. Otherwise, a sewing needle or a straight pin will do...”

The email then describes a process to prick the fingers and ears of the patient and induce blood-letting:

“After a few minutes the victim should regain consciousness...Wait till the victim regains his normal state without any abnormal symptoms then take him to the hospital. Otherwise, if he was taken in the ambulance in a hurry to the hospital, the bumpy trip will cause all the capillaries in his brain to burst. 'I learned about letting blood to save life from Chinese traditional doctor, Ha Bu Ting, who lives in
Sun Juke. Furthermore, I had practical experience with it. Therefore, I can say this method is 100% effective.”

The email describes a scenario that occurred in 1979 where the process worked exactly as described:

“...There were no ill after effects....On the other hand, the usual stroke victim usually suffers Irreparable bursting of the brain capillaries on the way to the hospital. As a result, these victims never recover.' ...Therefore, stroke is the second cause of death...If we can all remember this blood letting method and
start the life saving process immediately, in a short time, the victim > will be revived and regain 100% normality....IF POSSIBLE PLEASE FORWARD THIS AFTER READING . YOU NEVER KNOW IT MAY HELP SAVE A LIFE FROM STROKE.”

I don’t usually respond to these types of emails (let alone forward them!), but I felt compelled to respond to this one because of the dangers associated with it. Here’s my response:

This is dangerous and unfounded.  As a Canadian-trained and licensed family physician with additional training in neurology and stroke rehabilitation, I wouldn't advise this.  If the person gets better, it might and very likely occurred because it was only a TIA (transient ischemic attack) and not at all related to blood-letting.  It has been medically proven that "all the capillaries in the brain" do NOT burst upon arrival to the hospital.  It is not plausible that a "bumpy car ride" would burst all the capillaries and worsen the situation.  Any bump in a road is NOTHING compared to what is occurring in the brain already, and is only as bumpy as being transported on a stretcher within the hospital.  None of the various radiological tests (CT scans/MRIs/PET scans/arteriography) and post mortem (autopsies) examinations have shown that these activities cause any damage, BECAUSE THERE IS NOT THIS TYPE OF DAMAGE SEEN IN THE TISSUE.  Also, it does not make sense that a neurological disease which presents on its own, would be miraculously reversed to "100% normality", let alone due to loss of a few drops of blood.  If that were the case, why not prick all babies for blood to PREVENT the stroke process from happening and eradicate the disease from humanity??!

STROKES ARE LOCALIZED INFARCTS (DEATH OF THE BRAIN TISSUE) IN THE BRAIN FROM LACK OF OXYGEN TO THE TISSUE DUE TO EITHER EMBOLI (BLOCKAGE OF A BRAIN ARTERY FROM CLOTS FORMED ELSEWHERE IN THE BODY), THROMBOSIS (CLOT FORMED AT THE SITE OF THE BRAIN ARTERY), OR HEMORRHAGE (A BLEED FROM THE BLOOD VESSEL IN QUESTION).  THE VARIOUS SYMPTOMS SEEN DEPEND ON THE AREA OF THE BRAIN AND BLOOD VESSEL AFFECTED.  THERE IS NO RELIABLE WAY TO DETERMINE WHAT TYPE OF STROKE/TIA YOU ARE FACING WITHOUT DIAGNOSTIC IMAGING (CT SCAN, MRI, ETC), SO BLOOD-LETTING, EVEN IF IT WORKED FOR ONE TYPE, WOULD NOT WORK FOR THE OTHERS AND THUS IS AT BEST, POTENTIALLY DANGEROUS/FATAL TO THE PERSON.  THIS IS BECAUSE MULTIPLE FACTORS, SUCH AS THE SIZE OF THE INFARCT, LENGTH OF TIME BEFORE ADEQUATE TREATMENT, AND GENERAL HEALTH OF THE INDIVIDUAL, DETERMINE THE OUTCOME.  IF YOU ARE WASTING TIME WITH THE PROCEDURE DESCRIBED, YOU ARE SERIOUSLY WORSENING THE CHANCES OF A GOOD OUTCOME.  THE TIME COULD BE SPENT GETTING THE PATIENT TO A HOSPITAL WHERE S/HE COULD BE RAPIDLY DIAGNOSED AND TREATED.  

Please beware of any "treatment" that:
- makes blanket statements about a disease that has many different causes and VERY different management approaches,
- claims anything 100%,
- gives vague evidence,
- does not provide any plausible mechanism of action (eg.  WHY would ear pulling work in this situation when a bumpy ride will worsen things?)
- deals with a life-and-death situation
- does not give full disclosure about the other treatments available and only presents one perspective
- comes to you without any references to back it up ("a Chinese professor"???)

Feel free to forward this back to the person who sent this to you as well as anyone you may have sent this to.  It may save a life, or rather, it may avoid an unnecessary death.

Denise M. Viardo Koh, BSc, MD, CCFP, MPH
ps.  Real medical doctors' (the ones with MDs aka medical degrees) credentials can be confirmed at the licensing body where they practice medicine.

2) “I got this e-mail from a friend and I have doubts about the efficacy of these exercises
I would like to ask the opinion of your daughter Dr. Denise Koh about this claims. Why do we have to believe everything that the Indian gurus tell us?”
The forwarded email was titled, “Health in Your Hand: Seven Mudras for Amazing Health Benefits” and detailed 7 hand positions/exercises which claimed numerous health benefits:
“...enhances the knowledge. ...increases memory power and sharpens the brain...Enhances concentration and prevents Insomnia...cure all psychological disorders like Mental, Hysteria, Anger and Depression ... reduces all physical weaknesses. 
It helps to increase the weight for weak people ...improves the complexion of skin and makes the skin to glow ...It makes the body active by keeping it healthy ...balances the water content and prevents all diseases which come due to lack of water...retains clarity in blood by balancing water content in the body...Prevents the pains of Gastroenteritis and Muscle Shrinkage...prevents all the diseases that occur due to the imbalance of the air....cures Rheumatism, Arthritis, Gout, Parkinson's disease and paralysis without any medicine...useful for Cervical Spondilytis, paralysis to face and catching of nerve in neck ...corrects the disorder of gas in the stomach ...reduces the dullness in our body...relieves an earache within 4 or 5 minutes...useful for the deaf and mentally challenged, but not for inborn ones....sharpens the center in thyroid gland...reduces cholesterol in body and helps in reducing weight...reduces anxiety ...corrects indigestion problems... improves the power of life. Weak people become strong....reduces the clamps inblood vessels....improves immunity ...Improves the power of eyes and reduces eye related diseases...removes the vitamin deficiency and fatigue... regulates the excretory system... regulates diabetes ...cures constipation and piles...helps excreting the normal waste regularly ...benefits the heart. It works like injection in the reduction of heart attack. It is as powerful as sorbitate tablet. It reduces the gas content in body. ..strengthens the heart and regularizes palpitation ...regulates excretory system...redeems gastric trouble ... generates heat in our body.... stops production of phlegm and gives power to lungs ...cures severe cold and bronchial infection ...invigorates the body ....It is amazing but true.. If you want to see the results, start today!”

My response:

Hi,

I really don't have much to say about these exercises.  In my medical training, I would classify this type of "health care" under "Alternative Medicine," which we didn't go into much detail about.  The problem with a lot of Alternative Medicines/Therapies etc, is that most of these practices are anecdotal and are not supported by standardized research or regulated by well-established authorities.  For example, a lot of the "Herbal Supplements" are not regulated, and, because they are not listed under "Drugs", they don't need to pass the same standards/regulations that our drugs do.  So, the companies don't even have to put the amount they say they are putting in the bottle.  And I remember reading about some testing that was done (it was something like 20/20 or 5th estate) on many of these supplements which showed that many of them contained dangerous additives, wrong dosages, and some didn't contain ANY of what they were claiming to contain!  Many of these treatments/therapies/herbs sell easily because the public has a general fear of medical science and research.  They think that synthetic medications are inherently bad for you, and herbs are  "natural" and therefore harmless.  I approach any practice or supplement (synthetic or "herbal") the same--I try to evaluate who is promoting it and what type of research, if any, supports it.  We have to weigh these things against the potential harm they may cause.  

In this particular case, I would say that the exercises don't seem terribly harmful, so if a person believes they may work, I wouldn't tell them not to.  But in this case, I am relying more on the placebo effect to do good than on any basis the exercises claim; I believe that if a person believes in a therapy, they have a much better chance of responding better, whether the therapy works or not.  However, if a person were going to rely on these exercises and refuse any therapies/treatments that have much stronger research behind them, I would strongly urge the person to try at least both.

Superstition isn't always harmful, but ignorance almost always is.

Cheers,
Denise