by SR, in discussion with PH and TAB. The search, data extraction and synthesis was conducted primarily by SR in close collaboration with TAB and TB. The first draft of the paper was prepared by SR, with major contributions to further drafting from all authors. All authors read and approved the final manuscript.

The work was funded by the National Health and Medical Research Council of Australia (NHMRC) through its Partnership Centre grant scheme (grant GNT9100001). NSW Health, ACT Health, the Australian Government Department of Health, the Hospitals Contribution Fund of Australia and the HCF Research Foundation have contributed funds to support this work as part of the NHMRC Partnership Centre grant scheme. TAB was supported by a National Health and Medical Research Council Boosting Dementia Research Leader Fellowshipirrational and tyrannical tendencies common among island politicians.

In 1994 Lingle, then Mayor of Maui County, conspired with a coven of quacks to defraud thousands of people of Hawai'i, as well as visitors from other states and nations. They organized an all-day festival of fraudulent medicine that they called a women's health conference. I attended along with several hundred others. There I sampled a smorgasbord of preposterous and hilarious quackery, including a talk by an obviously delusional crystal healer. Lingle also happened to be in the audience.

When the woman had run out of tall tales about her crystals healing diseases and making appliances and vehicles run better, and about an angel who tells her which crystals heal which diseases, she asked if anyone had any questions. No one else