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Camelford autopsy verdict due on 14th

Discussion in 'Other Health News and Research' started by Esther12, Mar 6, 2012.

  1. Esther12

    Esther12 Senior Member


    Camelford water poisoning: Aluminium in brain 'beyond belief'

    Post-mortem tests showed high levels of aluminium in Carole Cross's brain

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    A woman who lived in a town where aluminium sulphate was added to the water supply had aluminium levels in her brain which were "beyond belief", an inquest into her death has heard.

    Carole Cross lived in Camelford, Cornwall, in the 1980s.

    The 59-year-old died in 2004 from a rare form of dementia.

    Professor Chris Exley said mineral water could still flush aluminium from the brains of people affected by the water poisoning in 1988.
    Health problems

    About 20,000 customers were affected when a relief lorry driver mistakenly added 20 tonnes of aluminium sulphate to drinking water at the Lowermoor treatment works in July 1988.

    Prof Exley, from Keele University, told the inquest in Taunton that although the incident happened 24 years ago, if people living in Camelford at that time were to drink daily at least one litre of mineral water with a high silicon content of more than 30mg, it would help remove aluminium from their brains.

    In 2010, an earlier sitting of Mrs Cross's inquest was told that on the night of the incident the then South West Water Authority (SWWA) was inundated with hundreds of complaints about dirty, foul-tasting water.

    But the authority insisted the water was safe to drink and no warnings were issued to the public for at least two weeks.

    Local residents reported a range of health problems, including stomach cramps, rashes, diarrhoea, mouth ulcers and aching joints, and some even said their hair had turned green from copper residues.

    Mrs Cross lived on the outskirts of the town and later moved to Dulverton in Somerset. She died at Taunton's Musgrove Park Hospital in 2004.
    Rodent experiment

    She had cerebral amyloid angiopathy (CAA) - also known as congophilic angiopathy - and her husband Dr Doug Cross has, for many years, believed the high levels of aluminium she was exposed to in Camelford contributed to her death.

    Prof Exley told the inquest the aluminium levels found in her brain were "beyond belief".

    The inquest also heard from a neuro pathologist from the University of Southampton, who agreed the aluminium could be linked to Mrs Cross's death.

    Professor James Nicoll said during an Italian study - one of several which have taken place into possible links between the metal and Alzheimer's - rodents were given aluminium in their drinking water over several months.

    Scientists found the rodents developed the same rare form of dementia as Mrs Cross.

    However, he said that alone could not be relied on and more research was needed.

    Technological advances in brain scanning could provide evidence but more funding would be necessary.

    Prof Nicoll told the inquest people living in Camelford should be tested.

    The last hearing of Mrs Cross's inquest was held in November 2010 but following testimony from scientists, West Somerset Coroner Michael Rose agreed to the water authority's request to adjourn the inquest.

    The inquest is due to conclude on Tuesday, with a verdict expected on Wednesday 14 March.
  2. Esther12

    Esther12 Senior Member

    Some use Camelford as an example of 'hysteria':

    The Camelford Hysteria: A Lesson for ECT?
    By Max Fink, MD | 01 October 2006

    The inadvertent deposition of 20 tons of aluminum sulfate in a reservoir downstream from the local water purification plant in 1988 gave the villagers in the small town of Camelford, in southeastern England, discolored acid-tasting drinking water for 3 days.1,2 Nausea, vomiting, rashes, and mouth ulcers were quickly reported. Hair, skin, and fingernails were stained brown. Rumors of shoals of dead fish in local rivers, widespread sickness in farm animals, and disruptive behavior in schoolchildren soon spread on local and national television and radio. Many complained that the water company was slow to respond, and when it did, that it gave false reassurances.

    After the cleanup, official reports found the health risks from aluminum in the water to be esthetic, not toxic, because aluminum is not absorbed and aluminum poisonings are rare. Rather than assuaging anxiety, the reports encouraged people's fears. Adding insult to injury, newspapers misquoted the official report as claiming the residents' complaints were due to hysteria. Although the water standards were now excellent, litigation was under way as potential claimants formed a pressure group.

    Academic reports that aluminum in drinking water was a risk factor for Alzheimer disease (AD) further inflamed indignation. Could the hazard of exposure lead to AD several years later? The thought was mixed in with reports that mad cow disease was characterized by a delayed onset of dementia. Soon, complaints of memory loss, poor concentration, and mental and physical fatigue dominated the community clinical picture with tie-ins to Camelford.

    The cascade of events continued. Another commission assessed the evidence of long-term effects and despite the best evidence that there were none, the complaints persisted. These were finally quelled, in part, by out-of-court settlements. For the next decade, claimants related poor work performance, decline in memory, and symptoms of anxiety and depression to their Camelford exposure. The British Medical Journal recently reported that investigators have linked the death of a woman with a rare form of AD to the poisoning of the drinking water.3

    In discussing these events, British neuropsychiatrists David and Wessely1 see little evidence of biologic (toxic) consequence. Instead, psychiatric morbidity was encouraged by the normal levels of somatic symptoms in any community, by the focused anxiety for environmental events following a publicized incident, and by the opportunity for litigation. Professional acceptance of the possibility that exposure might have persistent long-term effects, despite the lack of objective evidence, contributed strongly to the beliefs.
    An application to memory loss in ECT?

    Does this experience shed light on the claims that electroconvulsive therapy (ECT) causes persistent deficits in memory? Effects on memory, common in ECT, come in 2 flavors--an immediate transient delirium and a rare persistent impairment in personal memory.4,5 Delirium is common with each seizure and is well documented by immediate measurable changes in brain chemistry and physiology. Its occurrence is anticipated and managed with the same skill as the blood loss in surgery.

    The second complaint is of a persistent loss of personal memories. Despite any benefits of ECT on the mental disorder, the patient complains that work is no longer possible because the treatments damaged the brain. Personal memories of experiences with family and friends are hazy, and patients are surprised when they meet people whose names and past relationships they cannot appreciate. They do not recall the names of their children, family holidays, or personal events. They are, however, able to carry on normal daily activities, read and write, make shopping lists, travel, and work about their home.

    Their complaints cast a public shadow on ECT practice. That the complaints have a biologic basis in the treatment is widely accepted by the public and by many professionals. Compensation is demanded through litigation, with psychologists and psychoanalysts serving as experts for the plaintiffs. The persistent complaint of personal memory loss has stigmatized ECT and discouraged its use despite its proven efficacy and safety.
    A disabled economist

    In a 1974 New Yorker, the medical science writer Berton Rouech described the travails of the economist, Marilyn Rice, who, after extended complaints of dental pain that was not relieved by extraction of all her teeth and replacement by dentures, "fell into a deep depression," lost her appetite, and experienced a 20% loss in weight.6 During psychotherapy, she ruminated about her mouth and gums and her belief that she had become ugly. A 9-week stay in a psychiatric hospital, although uneventful, left her no better. "I am on a rest cure with do-it-yourself treatment." On another occasion, she wrote: "After being turned into a monster by the orthodontist, I must adjust to life as a damned ugly woman."

    When her therapist despaired of success with psychotherapy, she was hospitalized for a course of ECT after which she wrote: "I felt just fine, perfectly relaxed and comfortable and also very hungry, as if I were making up for lost time."

    Although she had been playing bridge throughout the hospital course, she now felt that she could no longer recall the cards. She returned home and described "a deja-vu experience." She believed that her memory was altered: "I was puzzled--but only vaguely. I really felt too vague to care. Nothing really bothered me. . . . I felt physically very well . . . and calm. I didn't have enough memory to think, or even worry. . . . Work was just something that drifted across my mind from time to time. It didn't interest me. I was too comfortable doing nothing."

    After a month at home, she returned to work. Although her associates appeared familiar and she remembered their names, she found the work unfamiliar. "I was terrified. I've never been a crying person, but all my beloved knowledge, everything I had learned in my field during 20 years or more, was gone. I'd lost the body of knowledge that constituted my professional skill. I'd lost everything that professionals take for granted."

    The preoccupation with dental pain and feelings of ugliness were now gone, replaced by a preoccupation with memory. She retired on medical disability. "I mean, I mustn't give the impression that my experience with electric shock was a total disaster. There have been some beneficial results. For one thing, my physical health has improved. I am beginning to eat again, my digestion is much improved, and I have no trouble with sleep. I also feel emotionally relaxed. And I've lost a lot of bothersome inhibitions."

    A malpractice action against the psychiatrist who administered ECT failed. She sought help in hypnosis and psychotherapy and successfully organized an anti-ECT advocacy group, the Committee for Truth in Psychiatry. She attended open meetings of psychiatrists and complained that ECT had been administered without prior explanation and that the price was a loss of memory. She read and critiqued the ECT literature. At a meeting concerning progress in ECT research in 1982, she debated the literature with ECT experts, citing articles correctly. She had no relapses of her depressive illness.

    After her death, her advocacy group was led by another patient who also complained of persistent and devastating memory loss after a course of ECT. Her malpractice suit against the psychiatric hospital failed. Before ECT, she had been hospitalized for multiple suicide attempts, threats that did not materialize in her subsequent history.
    An enabled lawyer

    Another patient, a Vermont lawyer, described her personal journey through recurrent depression and resolution with ECT in an article in the Journal of ECT in June 2000.7 Although the article does not offer the usual details of a case study, she writes that she suffered episodes of depression that responded to medication in 1987 and 1989. A relapse in 1993 did not respond to medication, and from late 1995 through early 1996 she received 33 ECT treatments (initially unilateral and then bilateral).

    She described the experience: "Occasionally, I feel bitter. More often, it is a sadness, a sense of deep loss that may not even have had to happen. It is a grief that keeps deepening over time, because there is hardly a week that goes by that I do not discover yet another part of my life that is lost somewhere in my memory cells."

    She continued: "Despite that, I remain unflagging in my belief that the electroconvulsive therapy I received . . . may have saved not just my mental health, but my life. If I had the same decision to make over again, I would choose ECT over a life condemned to psychic agony, and possible suicide."

    Her memory loss was severe: "My long-term memory deficits far exceed anything my doctors anticipated, I was advised about, or that are validated by research." She had forgotten "hosting and driving Mother Teresa for a full day visit to Los Angeles in 1989; the dinner reception for my National Jefferson Award . . . with my co-honoree General Colin Powell."

    About her recovery she wrote: "As the 6-month marker came and went with only partial recovery of my recollections for past events, my focus began to change. I was again not doing as well emotionally, which affected my positive attitude." A detailed research of the literature on cognition and ECT led to the conclusion: "I was completely stunned by the discrepancies I found. While multiple studies found any long-term amnesia to be extremely rare,[8] informal accounts, advocacy group information, and newspaper exposs described extensive and broad-based risks.[9-11]"

    After detailing her complaints of loss of memory, she offered the following: "I think that this lingering feeling of abandonment of care by the psychiatric profession, both as anindividual and in a deeper sense on behalf of my peers, is strongly related to the part of me that still feels so damaged by my memory loss."

    Despite the severity of her complaints, she took an active interest in community affairs and participated in radio interviews.12 In 2002, she was elected to the Vermont House of Representatives. She brought a malpractice lawsuit for improperly performed ECT against the Vermont hospital. In a settlement, the hospital formally adopted Vermont's informed consent guidelines and agreed to make a new informed consent video available to all prospective ECT patients.
    Camelford and memory complaints in ECT

    David and Wessely,1 and more recently Trimble,2 describe the elements that contribute to a somatoform disorder: an event perceived as traumatic, normal levels of body symptoms, persistent anxiety, endorsement of the association between trauma and symptoms by the professions, and the opportunity for litigation.

    These elements are met in Camelford by the unpleasant community experience of sour, discolored drinking water; psychological symptoms of anxiety, problems in recall, and social difficulties in the home and workplace in a portion of the community; the experience perceived as trauma; consequences not excludable by experts; endorsement by some in the professions; and the drive for reimbursement. These elements endorsed a psychiatric illness that was accepted as likely by the community despite an absence of objective evidence.

    The same elements apply to the complaints of persistent memory effects of ECT and direct our attention to a psychological rather than a biologic basis for the persistence of the complaints. Patients wake with headache, confusion, and widespread muscle aches, and the experience is seen as traumatic.

    The ECT experience is publicly perceived as traumatic. The images in One Flew Over the Cuckoo's Nest, Titicut Follies, and A Beautiful Mind forcefully present the treatment as horrific. The public is frequently reminded that psychiatrists abuse their patients, the most recent being a story in the New York Times alleging brutalization of patients in Turkey with the use of unmodified ECT.13

    The effects of seizures on memory are endorsed by the psychiatric profession.5 In the consent process, the risks acknowledge: "Patients often become confused and may not know where they are when they awaken. . . . Memory for recent events, mainly for the period of illness and the treatment may be disturbed. Dates, names of friends, public events, telephone numbers, and addresses may be difficult to recall. In most patients, the memory difficulty is gone within 4 weeks after the last treatment; but rarely the problems remain for months, or even years."

    Psychologists assessed the difficulty: "It has also become clear that for rare patients the retrograde amnesia due to ECT can be profound, with the memory loss extending back years prior to the receipt of the treatment."14 The same essay averred: "Some patients experience profound memory losses due to ECT. Most ECT practitioners have encountered fully credible patients who are distressed by the magnitude of their persistent post-ECT amnesia."

    A caveat, however, is entered after psychological examination: "Another complication is that some patients with persistent memory complaints following ECT have no treatment-related deficits."14 Indeed, "Most recent studies indicate that subjective memory improves following ECT."15
    Somatoform disorder

    Michael Trimble, the British neuropsychiatrist at London's Institute of Neurology, offered a detailed history of hysteria in Somatoform Disorders: A Medicolegal Guide.2 Unexplained symptoms, inconsistent with known anatomy, physiology, or biology, have been a focus of medical practice for millennia. Belief in displaced uteri as the cause led to the term "hysteria." In the past century, psychodynamic and psychological principles redefined the syndromes as "somatoform" or "somatization" or "posttraumatic." "Hysteria" is now politically incorrect. Waves of classic hysteria are still frequent, however, in shell shock, chronic fatigue syndrome, and the Vietnam and Gulf War syndromes. In each instance, a physical explanation is sought, and when none is found, the psychological nature of the syndrome is emphasized. The illness is sustained by disability compensation. When the possibility of compensation is removed, the incidence of the illness goes down.2

    Different expressions of hysteria are accepted in different social eras.16 The faints and "convulsions" of the Victorian era highlighted by the dramatic presentations of Charcot have become pass in the present era. We accept chronic fatigue syndrome, fibromyalgia, posttraumatic stress syndrome, pseudoseizures, and false memory syndrome as systemic disorders.

    Complaints of persistent memory loss in otherwise well-functioning individuals after recovery from a psychiatric illness through ECT are best viewed as a conversion reaction or a somatoform disorder. The Camelford experience is a model for the complaints of ECT's profound personal memory losses.

    Dr Fink is professor of psychiatry and neurology at the State University of New York at Stony Brook. He is the author of Electroshock: Restoring the Mind (Oxford University Press), founding editor of The Journal of ECT, and co-author of Catatonia: A Clinician's Guide to Diagnosis and Treatment and Melancholia: The Diagnosis, Pathophysiology and Treatment of Depressive Illness (Cambridge University Press).

    1. David AS, Wessely SC. The legend of Camelford: medical consequences of a water pollution accident. J Psychosom Res. 1995;39:1-9.
    2. Trimble M. Somatoform Disorders: A Medicolegal Guide. Cambridge, UK: Cambridge University Press; 2004.
    3. McIntosh K. Screen Camelford residents, researchers say, after woman's death linked to poisoned water supply. BMJ. 2006;332:992.
    4. Abrams R. Electroconvulsive Therapy. New York: Oxford University Press; 2002.
    5. Fink M. Electroshock: Restoring the Mind. New York: Oxford University Press; 1999.
    6. Rouech B. As empty as Eve: annals of medicine. New Yorker. 1974;9:84-100.
    7. Donahue AB. Electroconvulsive therapy and memory loss: a personal journey. J ECT. 2000;16:133-143.
    8. Sackeim HA. The cognitive effects of electroconvulsive therapy. In: Thahl LJ, Moss WH, Gamzu ER, eds. Cognitive Disorders: Pathophysiology and Treatment. New York: Marcel Dekker; 1992.
    9. Breggin P. Electroshock: Its Brain-Disabling Effects. New York: Springer Publishing Co; 1979.
    10. Cauchon D. Patients often aren't informed of full danger. USA Today. Dec 6, 1995:1.
    11. Vermont Protection and Advocacy. Position paper on ECT. April 11, 1996.
    12. Anne B. Donahue: 2003 Welcome Back Award Honoree in the Lifetime Achievement Category. Available at: donahue_lifetime.pdf. Accessed August 28, 2006.
    13. Smith CS. Abuse of electroshock found in Turkish mental hospitals. New York Times. September 29, 2005; sect A:3-13.
    14. Sackeim HA. Memory and ECT: from polarization to reconciliation. J ECT. 2000;16:87-96.
    15. Prudic J, Peyser S, Sackeim HA. Subjective memory complaints: a review of patient self-assessment of memory after electroconvulsive therapy. J ECT. 2000;16: 121-132.
    16. Shorter E. From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era. New York: The Free Press; 1992.

    The Wessely paper cited can be read here: Legend of Camelford.pdf
  3. SilverbladeTE

    SilverbladeTE Senior Member

    Somewhere near Glasgow, Scotland
    I just hope this nice (as in precise, it's horrible I use the world in specific meaning), hard and bold factual horror, crucifies Wessely and destroys his sick, evil career of being as "premiere' cover up artist" for Big Business and government.
    Remember, at least 20 folk have died because of this incident, many more might have died but not been ntoiced as related ot the poisoning because they moved away, the authorities didn't spot it etc

    In Two cases, it only came ot light because of the unusual deaths they suffered and the determination of pathologists and coroners to find out how it happened.

    The UK government has repeatedly refused ot have a Public Inquiry about this disaster, because it's linked to the treasonous asset stripping of our nation that went on
    the whole sale UNDER selling of our public utilities to private industry or "PLC"
    it was an enormous robbery that those scum don't want investigated, especially since many of the polticians made "nice little earners" from such (insider trading, relatives buying stock, becoming execs on the new privatized companies' boards etc).
    ahimsa likes this.
  4. Esther12

    Esther12 Senior Member

    I really don't know much about Camelford, but I've just been reading some bits in the BMJ, and it does seem that many psychiatrists took a very 'pragmatic' approach - primarily concerned with encouraging people to believe relaxing things, rather than finding out the truth about whether consuming water with lots of aluminium is harmful.

    I was just reading some old Bertrand Russell stuff on the way in which pragmatism serves to benefit the interests of those in positions of power and authority, and it does seem that he predicted many of the problems which resulted from a pragmatic psychosocial approach to CFS.

    An easy to understand critique of more extreme forms of pragmatism, that still has a bearing on CFS stuff imo, even if pragmatists now tend to talk of functionality or mental health, rather than pleasantness:

    Snow Leopard likes this.
  5. Enid

    Enid Senior Member

    Seems the world claimed by the Psyches is shrinking now. Pragmatic approach = power philosophy, I can believe it as a psychiatrist in Accident and Emergency tried to persuade me whatever I had (me collapsed) was just my imagination.

    Don't even mention SW et al and cosying cronies. (Except of course to correct). God Almighty how their papers bore.
  6. Glynis Steele

    Glynis Steele Senior Member

    Newcastle upon Tyne UK
  7. Firestormm


    Cornwall England
    Thanks Glynis. A few extracts from your linky:

    'Mr Rose said while the incident may have contributed to her death, he could not conclusively say it caused it.

    While there was a "very real possibility" the ingestion of aluminium contributed to her death, he said there was "only a slight possibility" it caused her death.

    Despite being inundated with nearly 1,000 complaints, the then South West Water Authority (SWWA) insisted the water was safe to drink and advised customers to disguise the "foul" taste by mixing it with orange juice to make it more palatable.

    Mr Rose criticised the water authority for not informing the public about the poisoning for 16 days, describing the delay as "unacceptable".

    Shortly after the incident, people in the area began reporting a range of health issues, including stomach cramps, rashes, diarrhoea, mouth ulcers and aching joints.

    When she died at Taunton's Musgrove Park Hospital, she had cerebral amyloid angiopathy (CAA) - also known as congophilic angiopathy - a very rare form of dementia.

    Post-mortem tests revealed very high levels of aluminium in her brain - levels described at the inquest by expert Professor Chris Exley from Keele University as "beyond belief".

    He said even 24 years later, people who lived in Camelford at the time of the poisoning should drink a litre of mineral water with a high silicon content every day as this could help flush aluminium from their bodies.

    During the inquest at Taunton, evidence was also given by Professor James Nicoll, a neuro-pathologist from the University of Southampton.

    He said rodents that were given aluminium in their drinking water as part of an Italian study into possible links between the metal and Alzheimer's developed the same rare form of dementia as Mrs Cross.

    Prof Nicoll said further research was needed as well as more funding to carry out brain scans using advanced technology.

    I lost track of all this but has anyone yet made compensation claims? I wonder if this verdict/finding will lead to (more) compensation claims?
  8. Esther12

    Esther12 Senior Member

    The caring psychologists would be concerned that this would be the very worst thing to do, and just lead to more stress and focusing upon symptoms. Far better for people to just get on with their lives, and not cause any bother to those in positions of power and authority.
  9. Yogi

    Yogi Senior Member

    Does anyone have good connections in the media as it would be good for the media to investigate and report on how discredited Wessely is from this Camelford affair? Alternatively it would be good for the Countess of Mar to raise this serious matter of Wessely in Parliament. Also should the GMC not censure Wessely over this?
  10. Firestormm


    Cornwall England
    But what about that lady above then? That has to be open to compensation now doesn't it? Or maybe not as cause of death wasn't conclusive.... always a damned caveat and I'm sure the defence would fight any claim based on that one point alone, but I wonder if any claims have been successful...

    Of course actual harm would need to be proven I guess but say for example you suffered - I don't know - diahorrea or something and you'd been to the GP and he'd said 'That be that water you drinkin'' and told you not to drink anymore of it etc. etc. then wouldn't that be evidence?

    I'm probably out of touch to be fair. I wasn't in Cornwall when this all broke and I think my parents were living in Dorset at the time. We're only 10 minutes away from Camelford now. Sorry - just a little bit of personal information....:D
  11. Esther12

    Esther12 Senior Member

    I don't know about this specific case, but it wouldn't surprise me if they got nothing - it really does seem that people in positions of weakness pretty consistently get screwed over, often in ways justified through pragmatism and paternalism.
    Firestormm likes this.
  12. Esther12

    Esther12 Senior Member

    No-one will be held accountable when they're on the side of those in power. No-one got fired because of the claims made about Iraqi WMD, which was a rather bigger deal!

    Also, while Wessely's paper is often cited as showing Camelford to be a typical example of environmental concerns leading to hysteria, he never said that we could know the aluminium did not cause neurological problems. It's all very pragmatic instead, with few truth claims that could be falsified.
  13. Sean

    Sean Senior Member

    And lots of wiggle room and plausible deniability.
  14. anciendaze

    anciendaze Senior Member

    This use of the word pragmatic nearly reverses standard meaning. I get what you're saying, but others may be misled. They aren't saying things because they are true, merely to achieve a polemical purpose. The result is useful for denying claims, not for solving any medical problems. Ordinarily, I would use the word pragmatic to describe solving problems, even if you don't understand how a method works.

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