Definition of 'quack' in the public debate on alternative medicine

In May 1999 the Amsterdam Court of Justice decided that a retired internist and propagandist of his own alternative cancer therapy, could rightfully be called a quack by his critics. Recently this judgment was reversed on appeal. The first court used the medical definition of quackery: a treatment of which the supposed benefits are unsubstantiated. The court of appeal, however, took into consideration that to the general public calling someone a quack is an indication that this person is a swindler and practises medicine unlawfully. This definition is supported by the most authoritative Dutch dictionary. Apparently a different semantic interpretation of the term quack has led to these strongly diverging verdicts. The terms quack and quackery are indispensable in the public debate on alternative medicine.     

Alternative clinical-chemical laboratories: providers of incorrect or non-existant diagnoses

Until recently, alternative doctors and healers used to employ alternative ways of making their alternative diagnoses such as electro-acupuncture, iridiscopy, plantar reflexology, live blood analysis, aura reading and bioresonance methods. Two recent papers report the emergence of unjustified diagnoses, resulting from clinical chemistry testing in commercial laboratories with an alternative philosophy and character. Dutch law considers medicine to be a profession for which no special knowledge is demanded. Even incorrect diagnostic procedures and the diagnosis of non-existent diseases by these laboratories is not illegal, in spite of the resulting detrimental effects to the health and the purse of patients. Some would consider the Dutch law in this respect too liberal.     

Induction of type 3 deiodinase activity in inflammatory cells of mice with chronic local inflammation

During illness, changes in thyroid hormone metabolism occur, so-called nonthyroidal illness (NTI). NTI has been characterized by a fall of serum T(3) due to decreased extrathyroidal conversion of T(4) into T(3) by liver type 1 deiodinase (D1), without an increase in serum TSH. Type 3 deiodinase (D3) was thought not to play an important role during NTI, but recently it has been shown that D3 activity is up-regulated in liver and skeletal muscle of critically ill patients related to hypoxia. We studied D3 gene expression and activity in liver and muscle/subcutis of mice during illness, which was induced by two different stimuli: bacterial endotoxin (lipopolysaccharide) administration, resulting in an acute systemic response, and a turpentine injection in each hindlimb, resulting in a local sc abscess. Lipopolysaccharide induced a rapid decrease in liver D1 and D3 activity but not skeletal muscle of hindlimb. In contrast, local inflammation induced by turpentine did not decrease liver D1 and D3 activity but increased markedly D3 activity in the muscle/subcutis sample containing the abscess, associated with strongly increased IL-1beta and IL-6 mRNA expression. Inflammatory cells, surrounding the abscess showed D3 and T(3)-transporter monocarboxylate transporter-8 immunoreactivity, whereas muscle cells did not show any immunoreactivity. In conclusion, local inflammation strongly induces D3 activity in inflammatory cells, especially in invading polymorphonuclear granulocytes, suggesting enhanced local degradation of T(3).     

Severe disciplinary measures in the Millecam case: important precedent for revising the rules of conduct by scientific associations and the KNMG

The popular 45-year-old Dutch actress Sylvia Millecam died in August 2001 from untreated advanced breast cancer. She refused standard medical treatment and sought solace in many alternative healers, including three medical physicians. The Dutch Healthcare Inspection accused the three physicians of malpractice and asked the Medical Disciplinary Tribunal to pass judgment. In April 2006 one physician was struck from the physician register and the other two were suspended for 1 year and 6 months, respectively. These unusually severe measures were based mainly on the fact that they had neglected professional standards as defined by specialty boards, they had presented themselves as professional physicians and they had not tried hard enough to convince Millecam of the need for standard treatment. The Tribunal did not accept the strong desire of the patient to undergo only alternative treatment as a defence. Notably, the judgment of the Tribunal seems to be more severe than the present bylaws of medical-scientific bodies and the Dutch Medical Association (KNMG), which are apparently too lenient regarding the use of alternative treatments by their members.     

Human endotoxemia induces down-regulation of monocyte CC chemokine receptor 2

Upon injection of Escherichia coli lipopolysaccharide into human volunteers, the monocyte density of CC chemokine receptor 2 (CCR2) decreased. Minimal CCR2 density was observed 4 h after injection. Peak plasma concentrations of the CCR2 ligand monocyte chemotactic protein 1 and of tumor necrosis factor alpha were reached after 4 h and 2 h, respectively.     

The phenomenon of the inducement of demand and various concepts in the economics of health

The article looks at the behaviour of practitioners and patients from an economic point of view, in particular at supplier-induced demand (SID). The objective is to be able to describe the factors which impact on the market for health care. To define the market for health care/dental care in general and the SID concept in particular, the following economic terminology is relevant. uncertainty, asymmetric information, moral hazard, and the agency relationship between practitioner and patient. Essentially SID results from the existence of asymmetric information (information "gap") on the health care market. The patient is less informed than the practitioner and cannot accurately assess his need for medical care. Hence decision-making authority is delegated to the practitioner who acts as the patient's agent to determine the optimal (amount of) care. This enables the practitioner to influence the demand for medical/dental care. If the practitioner is more interested in the rate of return than in the patient s need for care, a difference might arise between the care recommended by the practitioner and the care the patient would have asked for if he had the same level of information as the practitioner. This difference is called the amount of SID.