Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
Academia
We are all interested in the relationship between our health and what we eat. What a pity that so little is known about it.
The problem, of course, is that it almost impossible to do randomised experiments, and quite impossible in most cases to make the experiments blind. Without randomisation there is no way to be sure about causality, and causality is all that matters. All you can do is measure “associations” and that sort of information is simply unreliable.
For example, if you simply observe that people who eat a lot of dark green vegetables are healthier than those who don’t, there is no reliable way to tell whether their health is caused by eating the vegetables. It is just as likely that, for example, rich people are healthier because the are rich, not because they eat more vegetables. The answer, though usually not known, is the only thing that matters for offering advice. The crucial problem is that, in the latter case, it will do no good at all to bully a poor person to eat more vegetables: their health will not improve because their bad health was caused by poverty, not by lack of vegetables.
It is precisely this difficulty that results in the constantly conflicting advice that we are given about diet. I can’t think of any single thing that does more harm to real science than the fact that one week we are told that red wine is bad and the next week we are told that red wine is good. No doubt both statements were based on a naive observational studies, the significance of which is vastly exaggerated by its authors (and often by their university’s media department too).
The first job of a scientist is to be able to say “I don’t know”. Under pressure from the government’s audit culture, and the HR apparatchiks who embrace it so eagerly, all that is forgotten only too easily. he lack of certain answers about diet leaves a vacuum into which not only naive scientists are sucked, but also it is a gift for hucksters who are eager to sell you expensive ‘supplements’, whether or not you need them. As always, it is a case of caveat emptor.
The questions are important to us all, so when sciencepunk pointed out to me a chance to check my own diet, I went for it. I try to keep pretty close to the current guidelines. Unreliable though they may be, they are the best we’ve got. So I went to the Nutriprofile site, and filled in the questionnaire, quite honestly (apart from saying I was 37 -I wish).
I eat plenty of fruit and oily fish every week so I though I’d do quite well. No such luck. I ended up being told I was deficient in iron and selenium, and at “risk of deficiency” in vitamin B5 (pantothenic acid), folate, vitamins D, E, K, magnesium, copper and potassium.
Uhuh, I must really be ill and I’d never realised it.
At the bottom of this analysis of all my deficiencies comes the sales pitch, “your personalised supplement recommendations”.”Strongly recommended” for me is Gold Standard A-Z Multivitamins (just click on the “buy now” button). I’m also “recommended” to buy Omega 3 1000mg capsules.
And then I’m invited to consider a whole list of other supplements
“The following products have been given a 1 star rating. This usually means they have been recommended to meet a specific issue raised by your NutriProfile. You should consider these supplements where you feel they could help if the issue is particularly important to you”
Here is the list.
- Selenium + A,C,E,
- Echinacea (“may help you maintain a healthy immune system”).
- OptiFive (antioxidant supplement)
- Co-enzyme Q10 (“may help you maintain energy levels” -look out for a forthcoming post on this scam)
- Memo Plus (“may help you maintain brain health and cognitive function”),
- Panax Ginseng (“may help you to maintain energy levels”
- Psyllium Husks
- Magnesium
- Vitamin D
- Ginkgo Biloba
- Probiotic
As always, there are lots of fantasies about “strengthening the immune system”. And the great antioxidant myth is exploited to the full.
Puzzled by this result, I got my wife to do the questionnaire, and also a particularly healthy and diet conscious colleague.
My wife was recommended to buy Omega 3 1000mg, Osteo Plus Bone health supplement (despite telling them that she already took calcium) and 50 Plus Multivitamins (“may help you address any deficiency in essential vitamins and minerals and may also help you maintain a healthy immune system and maintain energy levels. “). And then it may not.
My spectacularly healthy and diet conscious colleague got a strongly recommended (maximum 5 stars like me) for Gold Standard A-Z Multivitamins and for Omega 3 1000mg, as well as “recommended” for plant sterols, garlic and Opti-Omega 3.
Either I’m a lot unhealthier than I thought, or Nutriprofile is a sales scam.
You decide.
Is there anyone at all who does NOT need supplements?
By this stage I was getting suspicious so I sent the link to a professional dietitian, Catherine Collins of St George’s Hospital London. Unlike the people running the site, she has no financial interest in selling you pills. I asked her to fill in the questionnaire as a hypothetical person who had an ideal diet, based on current nutritional knowledge . Surely such a paragon of dietetic virtue would not need to buy pills too?
Don’t you believe it. At least she didn’t get any 5 star “strongly recommended”, but she did get “Recommended for you” Opti-Omega 3 (3.5 stars) and Gold Standard A-Z Multivitamins (3 stars). Plus, of course the whole list of “you may like to consider”, same as everyone seems to get.
So I asked Collins how it came about that everyone seems to end up being recommended to buy pills after going through all the questions. Here is what she said.
“Apparently my ratio of omega3:6 is unbalanced. not if you ate the amount of oily fish i’d put in, and used ‘vegetable’ oil which is mono-rich rapeseed. I think they’ve used the sunflower analysis to generate this distortion.
I disagree with absolute amounts of omega-3 per day. The amount I recorded meant I would easily exceed a daily intake of 500 mg of the important omega-3 fats, EPA and DHA
Low Vitamin B6 and folate – totally incorrect recommendation based on my entries
Potassium – the survey indicated concern that diet provided 200mg per day less potassium than recommended. This was incorrect, the flaw I assume being due to inability of the questionnaire to handle portion sizes. Should I have been worried even if this had been accurate? Of course not. Potassium is widespread across food groups, the most concentrated being fruit and vegetables. It is an essential nutrient, but its requirements are relative to sodium (‘salt’) intake.
Their omega-3 fat recommendation is double the FSA/ SACN suggestion of 450mg/d – they actually quote this in their supporting information but then say ‘experts say we need double’ [their experts are below]. This is highly misleading. We need a combination of omega-3 fats in our diet for health – not only the ‘fishy’ EPA and DHA, but also the readily available ALA, found in vegetable (rapeseed) oil
Omega 3:6 ratio -completely wrong based on the foods entered. Demonstrates a major flaws in the assumptions made about type and amount of foods in the diet.
Water recommendations. Totally inaccurate information based on the myth expounded by the health food industry and its workers that caffeine is a diuretic. This been extensively researched and proven to be not true ( Grandjeans excellent work). The only way in which a caffeinated beverage is ‘diuretic’ to someone who takes caffeinated drinks regularly is in the volume of drink consumed.
She concludes
“”This appears an elaborate pill-pushing exercise. Superficially reassuring in promoting the recognised FSA (Food Standards Agency] line – but then giving undue – and unjustifiable – support to the anecdotal ‘experts recommend’ to create what will be a powerful sell”
The comment about water intake stems from this bit of Collins’ Nutriprofile:
“Caffeinated drinks, fizzy drinks and alcohol do not count because, whilst they contain water, they are mild diuretics, ie. they boost urine output and therefore should only form a small part of your total fluid intake.”
This myth (aka nutribollocks) is quite contrary to what the real research (going back to 1928) says, Check “Laying the caffeine myth to rest” for the real story..
I’m told that Healthspan are now sending out the paper questionnaire in newspapers. Presumably this is to ensure that the poor, the elderly etc and others who that aren’t computer literate don’t miss their buying opportunity. How considerate of them.
Nutriprofile’s expert team
Who is the expert team behind Nutriprofile? Here they are.
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What do the real experts say about supplements?
The story you get is quite different when you ask somebody who is not trying to sell you something
The Food Standards Agency says
“Most people should be able to get all the nutrients they need by eating a varied and balanced diet. But if you choose to take supplements, it’s important to know that taking too much or taking them for too long can cause harmful effects.”
Harvard Men’s Health Watch says
“Harvard Men’s Health Watch suggests that the average man give up the multivitamin, at least until scientists solve the puzzle of folic acid and cancer.”
“If you eat a balanced diet that includes food from all the major groups, there should be no need to take vitamin supplements. The food you eat will provide you with all the vitamins and minerals you need. “
I guess we should not be surprised at the direct contradiction between this advice and that of the Nutriprofile questionnaire. After all, Nutriprofile was developed by a company, Healthspan, that is devoted to selling “supplements” with all the dubious claims and customer testimonials associated with the alternative health industry.
But this is what always happens when big business controls science.
Postscript
Oddly enough, Ann Walker’s experience seems to be much the same as ours. In an interview on the Healthspan site we read this.
Q: Which nutritional supplements do you choose to take?
A: I regularly take a multivitamin, vitamins C and E, fish oil, and a calcium and magnesium combination. I also take vitamin D during the winter and some herbs as and when they are needed.
Even if I have improved my diet, each time I complete the NutriProfile questionnaire my requirement for a multivitamin, calcium and magnesium, and a fish oil supplement are always thrown up.
Didn’t it occur to her to wonder why?
The sales pitch was followed up on 27 March the email arrived from Healthspan “Healthspan are offering you £5 to spend towards your recommended supplements”. One can’t say whether this offer goes to people who were not recommended supplements, because so far no such person has been found.
This afternoon I went to the Coliseum to see a revival of Jonathan Miller’s 1986 production of the Mikado. It was beautifully staged. The well-known patter song of Ko-Ko, the Lord High Executioner of Japan, begged for a version that deals with anti-science (original here). The serious post will come later. Meanwhile here’s some late night rhyming.
Ko-Ko
As some day it may happen that a victim must be found,
I’ve got a little list — I’ve got a little list
Of society offenders who might well be underground,
And who never would be missed — who never would be missed!
There’s the pestilential bureaucrats who want to send you on a course —
The HR folks who treat you not as human but as mere resource
Skills specialists who think that education just means training
And all ex-scientists who used to work, but now are only feigning
They’d none of ’em be missed — they’d none of ’em be missed!
Chorus.
He’s got ’em on the list — he’s got ’em on the list;
And they’ll none of ’em be missed — they’ll none of ’em be missed.
Ko-Ko
And that deluded nuisance, whom no one understands
The homeopathist – I’ve got her on the list!
All Reiki folks, pill hucksters and layers on of hands
They’d none of ’em be missed — they’d none of ’em be missed.
And herbalists and Princes who like to talk to trees
Those phony nutritionists who’ll treat you for large fees
And that singular anomaly, the acupuncturist —
I don’t think they’d be missed — I’m sure they’d not be missed!
Chorus.
You may put ’em on the list — you may put ’em on the list;
And they’ll none of ’em be missed — they’ll none of ’em be missed!
Ko-Ko
There’s the vision statement writer, and others of that sort
And the crystal therapist — I’ve got him on the list!
And the people who think long words are a substitute for thought
They never would be missed — they never would be missed!
Then those whose knight starvation makes them crave the honours list
So all below must suffer in case their chance is missed
And those who think that science can be judged by its citations
And so kill creativity by funding only applications
But it really doesn’t matter whom you put upon the list,
For they’d none of ’em be missed — they’d none of ’em be missed!
Chorus
You may put ’em on the list — you may put ’em on the list;
And they’ll none of ’em be missed — they’ll none of ’em be missed!
Postscript
I replaced two lines after my pedantic sister pointed out their imperfect rhyme and scansion. Personally I’m with Charles Babbage.
Here is letter that Babbage is said to have written to Tennyson after reading “The vision of sin”.
In your otherwise beautiful poem there is a verse that reads:
“Every moment dies a man
Every moment one is born”It must be manifest that, were this true, the population of the world would be at a standstill. In truth the rate of birth is slightly in excess of that of death. I would suggest that in the next edition of your poem you have it read:
“Every moment dies a man
Every moment 1 1/16 is born”Strictly speaking this is not correct. The actual figure is a decimal so long that I cannot get it in the line, but I believe that 1 1/16 will be sufficiently accurate for poetry.
I am etc,
(The Mathematical Gazette, 1927, p270)
This is the third post based on a recent trip to North America (here are the first and second)
One aspect of the endarkenment, the Wal-Mart model of a university, is very much the same in the US as in the UK. At one US university, an excellent scientist offered the theory that an alien spacecraft had scattered spores across the land which developed into HR staff who appeared at first sight to be human, and who colonised academia.
The penetration of quackademics into US universities is a bit different from in the UK.
In the UK, the plague is restricted to sixteen or so ex-polytechnic universities which, to their great shame, actually offer Bachelor of Science degress in subjects like homeopathy. There are bits of quackery in good teaching hospitals (such as laying-on-of-hands at UCLH), but not very much.
In the USA and Canada, this sort of “vocational” training does not occur much in universities, but in separate colleges. The situation is worse there though, insofar as these colleges have been allowed to award titles like ‘doctor of naturopathic medicine (ND)’, for work that in no respect compares with what the rest of the world has to do to earn a doctorate. This prostitution of academic titles has not happened to anything like the same extent in the UK. How our own quacks would love it if they were allowed to call themselves ‘doctor’ and sport the initials ND (so easily mistaken for MD at first sight).
It is on the clinical side where the situation is far worse than in the UK. Almost every university hospital, including Harvard, Yale and Stanford, has departments devoted to fairy-tale medicine.
Quacks use a number of euphemisms to make themselves sound more respectable. First they became ‘alternative medicine’, then ‘complementary medicine’. Now the most-used euphemism is ‘integrative medicine’, which is favoured by most US universities (as well as by the Prince of Wales). Raymond Tallis pointed out that this seems to mean integration of treatments that don’t work with treatments that do work.
An official roll of shame for North American universities can be seen here (35 in USA and 4 in Canada). 
A bigger collection of 44 universities has been posted by the incomparable Orac at the The Academic Woo Aggregator. He’s had good support in the USA from DrRW (R.W. Donnell), see particularly his articles on How did pseudoscience get admitted to medical school? and What is happening to our medical schools? Abraham Flexner is turning over in his grave.
All these outfits have two things in common. They all claim to be scientific and evidence-based, and none has produced any real evidence that any of their treatments work.
Here are a few examples of what’s going on.
Yale University School of Medicine
The usual theme is expressed thus.
“Through open-minded exploration and rigorous scientific inquiry, we aim to improve awareness and access to the best in evidence-based, comprehensive medical care available worldwide, with the goal of optimizing health and healing for patients”
The driving force behind the woo seems to be a fourth year medical student, Rachel Friedman, so I wrote to her to ask what useful alternative treatments had been established by research at Yale. But she could not identify any. All I got was this.
“My best advice would be to do some medline searching of metaanalyses” there’s been enough research into some of these modalities to provide for a metaanalysis.”
So she was unable to produce nothing (and anyway. metanalyses, useful though they may be, are not research).. A glance at the Yale publications page shows why.
The Scripps Institute
Scripps Center for Integrative Medicine says
“In use at Scripps since 1993, Healing Touch is an energy-based, non-invasive treatment that restores and balances energy to help decrease pain and relieve associated anxiety.
Healing Touch is performed by registered nurses who recognize, manipulate and balance the electromagnetic fields surrounding the human body, thereby promoting healing and the well-being of body, mind and spirit.”
“Balances energy”?
“manipulate and balance the electromagnetic fields surrounding the human body”?
This is just meaningless baloney. And it come from the Scripps Institute.
The Oregon Health & Science University
OHSU is an excellent and well-respected research university where I have many friends. It was a pleasure to meet them recently.
But it also has a big department of “Complementary and alternative medicine” and an “Integrated medicine service”. There are some good bits of advice mixed up with a whole range of crazy stuff. Take their page on homeopathy.
“This therapy treats ailments with very small amounts of the same substance that causes the patient’s symptoms.”
WRONG. In most cases it is zero amount. To brush this fact under the carpet is simply dishonest (and perhaps a sign of guilt). Then comes this (my emphasis)..
Explanations for why homeopathy works range from the idea that homeopathic medicine stimulates the body’s own natural defenses to the idea that homeopathic medicine retains a “memory” of the original substance.
However, there is no factual explanation for why homeopathy works and more research is needed.”
WRONG. This statement carries (twice) the expicit message that homeopathy does work, quite contrary to a mountain of good evidence that it is merely a placebo. The statement is deceptive and dishonest. And it comes with the OHSU logo.
The University of Arizona
” Heal medicine”, “Transform the world?” Modest uh?
The University of Arizona Program in Integrative Medicine is certainly not modest in its claims, but its publications page shows that it doesn’t even attempt to find out if its “therapies” actually work.
Here is an example. They are advertising their Nutrition and Health conference
heavily.
There’s nothing wrong with good nutrition of course, but the ‘alternative’ approach is instantly revealed by the heavy reliance on the great antioxidant myth.
And look at the sponsors. The logo at the top is for Pistachio Health, a company that promotes pistachio nuts: “Delicious and good-for-you, pistachios are nature’s super heart-healthy snack. Nutrient dense, full of fiber and antioxidants, pistachios give you more bang per calories than any other nut.”.
The other advertisement is ‘POM Wonderful’, a company that sells and promotes pomegranate juice, “POM is the only pomegranate juice you can trust for real pomegranate health benefits”
No doubt pistachio nuts and pomegranate juice are perfectly good foods. But the health claims made for them are just marketing and have very little basis in fact.
Now let’s look at the speakers. Take, for example, Dr David Heber, MD., PhD. He is director of the UCLA Center for Human Nutrition at the University of California, Los Angeles, a professor of Medicine and Public Health, and the founding Chief of the Division of Clinical Nutrition in the Department of Medicine. He is the author of several books including “What Color is Your Diet” and the “L.A. Shape Diet.” With the possible exception of the books, you can’t sound like a more respectable and impartial source of advice than that.
But hang on. Dr Heber is to be seen in a video on the Pistachio Health web site doing what amounts to a commercial for pistachio nuts.
OK let’s take a look at one of Dr Heber’s papers. Here’s one about, guess what, pomegranate juice. “Pomegranate Juice Ellagitannin Metabolites Are Present in Human Plasma and Some Persist in Urine for Up to 48 Hours”. The work was “Supported by the Stewart and Lynda Resnick Revocable Trust and from the NIH/NCI grant P50AT00151”. So no problems there. Well not until you check POM Wonderful in Wikipedia, where you find out that Stewart and Lynda Resnick just happen to be founders of POM.
Of course none of these interesting facts proves that there is anything wrong with the work. But they certainly do show that the alternative nutrition business is at least as much hand-in-glove with big business as any other form of medicine. And we know the problems that that has caused.
So, if you want impartial advice on nutrition, sign up for the 6th Annual Nutrition and Health meeting. For “MD, DO, ND & other doctors”, it will cost you only $845 to register .
The meeting is being run by The University of Arizona College of Medicine and Columbia University’s College of Physicians and Surgeons.
The University of Arizona is, incidentally, also the home of the famous (or perhaps infamous) Gary Schwartz (see also, here). He “photographs” non-existent “energy fields” and claims to be able to communicate with the dead, and he is director of its Human Energy Systems Laboratory at the University of Arizona. He is also head of the inappropriately-named Veritas Research Program and “Centre for Frontier Medicine in Biofield Science”. All of these activities make homeopathy look sane, but he is nevertheless part of an otherwise respectable university. In fact he is He is Gary E. Schwartz, Ph.D. is professor of psychology, medicine, neurology, psychiatry and surgery at the University of Arizona. Even more incredibly, this gets NIH funding.
Columbia University, along with Cornell, also has its own “Complementary, alternative, and integrative medicine“, defined as “the use of treatments, such as homeopathic medicine, ayurveda, botanical dietary supplements”. And their “Integrative Therapies Program for Children” is intimately tied up with a company called Origins, which is more a cosmetics company, Origins” (with all the mendacity that implies). They say
“Origins understands the importance of addressing wellness through an integrative approach,” says Daria Myers, President of Origins Natural Resources. “With our recent Dr. Andrew Weil collaboration, Origins demonstrated its support for the integrative wellness concept. Now, with the introduction of the new Nourishing oil for body and massage, we hope to bring not only a moment of comfort but also a healthy future to children enduring the fight of their life.”
Andrew Weil is, of course, the promoter of the Arizona meeting.
The corruption of Universities by this sort of activity is truly amazing.
Thursday 24 Jan.
One of the original reasons for going to North America was an invitation from the Toronto Secular Alliance and Center for Inquiry. The talk for them was given a lot of publicity, for example here and here and from the totally admirable Orac.
Toronto seems to be no worse than anywhere else when it comes to delusional thinking about medicine. It is, of course, the home of Ryerson University, the place that produced one of the most outrageous pieces of postmodernist nonsense on record. But when this sort of thing gets into really good universities, it is more worrying.
As a result of the publicity there was some media coverage (and a record 7109 hits on this site on Sunday).
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Friday 25th January, Reception and talk: Center for Inquiry. Science in an Age of Endarkenment: Some Examples from Scientific Fraud, Quackery, Religion and University Politics |
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The interview was broadcast on Sunday morning (28 Jan) and elicited a lot of correspondence. CBC made it available as a podcast which can be downloaded from CBC here. The endarkenment interview was the last 22 minutes (out of 64 minutes) [play the interview here (mp3, 20 Mb)]. |
Sunday Edition: the follow-upThe week following this CBC show, the backlash started. The Sunday Edition wrote
“A stirred-up hornet’s nest is a mild disturbance compared to the firestorm we unleashed last week over my conversation with Dr. David Colquhoun. Dr. Colquhuon [sic] is a gangly, pipe-puffing British pharmacologist who thinks all alternative medicine, all of it, is a fraud perpetrated by quacks. But he went further, somehow suggesting that those who believe in it probably supported Margaret Thatcher, Ronald Reagan and the Ayatollah Khomeini. He pooh-poohed acupuncture, chiropractic, homeopathy, even vitamins.
Well, his remarks opened the floodgates of listener mail, screaming for Dr. Colquhoun’s head on a pike. In a few moments, alternative or complimentary [sic] medicine strikes back. With the help of two experts, we will try to give the other side of contentious Colquhounism.”
The programme for 3 Feb 2008 started with a few emails from listeners, mainly of the “homeopathy cured my granny” type. Nothing of much significance there. But then Enright interviewed Dugald Seely of the Canadian College of Naturopathic Medicine and Dr. Kien Trinh of the DeGroote School of medicine at McMaster University in Hamilton. You can download the podcast here.
The flat earth problem.
Michael Enright was a good interviewer, but Sunday Edition suffers, like the BBC, from a problem. It is admirable that CBC, like the BBC, should strive to be ‘fair and balanced’, but it is not always easy to see what that means in practice. Is it fair and balanced to give equal time to people who think that the earth is flat and those who think it is spherical (OK, an oblate ellipsoid)? Perhaps, but it also
quite misleading because it can easily convey a very distorted idea of the balance of informed opinion. In this case the flat-earthers are the homeopaths and other alternative medicine advocates. That would not matter so much if the interviewers had enough knowledge of the subject to pin down the falt-earth advocates with the sort of penetrating questions that people like John Humphrys (of the BBC’s Today programme) are so very good at. When it comes to science, though, the flat-earthers tend to get away with murder, and the public can easily be left with a very distorted view. Which “expert” should they believe? If I had been given the option, I would have loved to debate the problems of alternative medicine directly with Trinh and Seely I could have asked then a few questions that Enright missed.
Let’s take a look at what happened at the follow-up.
Quackery at McMaster University
McMaster is one of many universities in North America that has chosen to betray the intellectual tradition of the enlightenment by buying into superstition (see the roll of shame here). The ‘contemporary medical acupuncture program appears to run under the aegis of the anaesthesia
department, though the fact that is doen’t appear on the department’s front page suggests there may be some embarrassment about it. The medical acupuncture program itself, has separate web pages which don’t seem to be on the McMaster server at all (they are on a private server, ThePlanet.com Internet Services, Inc.
As so often, these pages pay lip service to an ‘evidence based’ or ‘scientific’ approach, while doing nothing of the sort. In his CBC interview Kien Trinh agreed (twice) with my contention that trials had shown that it doesn’t matter where you put the needles. But then he failed totally to draw the obvious conclusion that ‘meridians’ are mumbo jumbo. He went right on taking the conventional mystical view of meridians and “energy” flow. Like most proponents of alternative medicine, Trinh seems to live in some sort of parallel universe in which the normal rules of logic don’t apply.
On wouldn’t expect regular anaesthetists to accept this sort of mystical nonsense, but it seems one would be wrong. When I wrote to the Chair of the Department of Anesthesia, at McMaster to ask about their relationship with acupuncturists there was no hint of embarrassement. Dr Norman Buckley, BA (Psych), MD, FRCPC, wrote
“It operates under the principles of evidence based medicine, and relates the concepts raised by the Acupuncture/traditional Chinese medicine to physiology anatomy et as it is more usually taught in Western schools.”
That would be all very well if it were true, but it simply isn’t true. The evidence just isn’t there, and the departments involved make no serious attempts to get evidence. In a later letter, Dr Buckley seems to acknowledge that it may be all placebo, but seems reluctant to offend anyone by saying so. That, I suspect, is how quackery has gained such a foothold.
It is good to keep an open mind, but if it is too open your brains fall out. Or, in another variant, if it is too open, someone will fill it with trash.
One looks in vain on Trinh’s web site for any good evidence. They quote approvingly the conclusion of a 1997 NIH Consensus statement that says “There is sufficient evidence of acupuncture’s value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.”, but forget to mention that this document is headed “This statement is more than five years old and is provided solely for historical purposes.”. The department doesn’t seem to do much original research, just to write endless reviews of other peoples’ work. The reviews aren’t too bad, and mostly they come to the right conclusion, that there is not enough evidence to come to firm conclusions. The difference from science is that this doesn’t dent their confidence for a moment. A typical sort of conclusion seems to be
Elbow pain. A review by Green et al. concluded “needle acupuncture [is] of short-term benefit with respect to pain, but this finding [is] based on the results of two small trials, the results of which [are] not able to be combined in metaanalysis.”
The results of thousands of years experience with acupuncture seem to be pretty pathetic so far..
Quackery at the Canadian College of Naturopathic Medicine (CCNM)
Unlike McMaster, CCNM isn’t a proper university, though nonetheless is hands out ‘doctorates’. Dugald Seely’s contribution was interesting insofar as he admitted that there was a lot of fraud and unjustified claims in the alternative medicine industry (never forget there are megabucks involved). What he didn’t explain was how he himself could be distinguished from the frauds. The problem, as always is the second-rate research that goes on in this area.
Take one of Seely’s papers, Adaptogenic Potential of a Polyherbal Natural Health Product: Report
on a Longitudinal Clinical Trial. Is only too typical: a small non-randomised, open-label (not blind) “trial” of a complex herbal mixture on 17 patients. The conclusion was, as it almost always is,
“Further research using a randomized controlled design is necessary to confirm the findings from this pilot study.”
In other words, no conclusion at all. Why is it that the proper trial never seems to appear? Could it be that naturopaths, and the wealthy industry behind them, are afraid to do proper trials? That is certainly the impression they give.
One way in which the alternative medicine industry operates is to invent new words with ill-defined meanings (and Big Pharma does it too). In case you were wondering about the word “adaptogen” it is defined as “Essentially the adaptogen supports the body’s ability to ‘adapt’ ideally to its environment. Essentially the adaptogen supports the body’s ability to ‘adapt’ ideally to its environment. ”
Whatever that means.
The Canadian College of Naturopathic Medicine offers the following “therapies”.
- acupuncture/Asian medicine
- botanical medicine
- physical medicine (massage, hydrotherapy, etc.)
- clinical nutrition
- homeopathic medicine
- lifestyle counseling
Well, nothing wrong with nutrition and lifestyle counseling as long as the claims aren’t exaggerated. But, as always, the claims that are made are vastly exaggerated. For example they claim
Homeopathic remedies are particularly effective for:
- depression
- anxiety
- allergies
- infections
- gynecological concerns
- skin conditions
- digestive problems
- chronic and acute conditions including colds and flu
These claims are simply not true, in my view. If you don’t believe me, check NELCAM (the NHS Complementary and Alternative Medicine Specialist Library). This is written by advocates of alternative medicine, yet it finds no convincing evidence for effectiveness of homeopathy in any of the conditions listed above.
Or, even more remarkably, from a report in Newsweek.
“Dr. Jack Killen, acting deputy director of the National Center for Complementary and Alternative Medicine, says homeopathy “goes beyond current understanding of chemistry and physics.” He adds: “There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment.”
The National Center for Complementary and Alternative Medicine (NCCAM) has, incidentally, spent almost one billion US$ billion of US taxpayers’ money and has come up with next-to-nothing useful.
So the claims made by the Canadian College of Naturopathic Medicine are not backed up even by people who are directly involved in alternative medicine You don’t have to be a rocket scientist to understand that the medicine contains no medicine.
| “the report is more hypothesis-generating for future research than a rigorous scientific study. Find us some money and we will do a proper job. You can quote me for that.” Professor David Smith (Oxford). Scientific adviser for Food for the Brain. |
For a quick synopsis, look at Holfordmyths.org.
Patrick Holford and Drew Fobbester are joint researchers and authors of the Food for the Brain Child Survey , September 2007 (pdf). Holfordwatch has made a very thorough study of this report, in eight parts (so far). They conclude
“HolfordWatch can not share the optimism for these claimed benefits and finds that there is insufficient data to support them in a robust manner.”
There are many detailed questions, but the basic problem with the report is very simple. The fact that is (a) self-selected and (b) not randomised make it just another naive observational study. The stunningly obvious confounder in this case is, as so often, the socio-economic background of the kids. That was not even assessed, never mind any attempt being made to allow for it.
This isn’t just pedantry because what matters is causality. It is worth very little to know that eating vegetables is correlated with high SAT score if the correlation is a result of having well-off parents. If that were the reason, then forcing kids with poor parents to eat vegetables would make no difference to their SAT score because their parents would still be poor. The only conclusion of the study seems to be that we should eat more fruit and vegetables, something that we are already lectured about in every waking moment.
Many questions about the report have not yet been answered by its authors. But the report has a panel of scientific advisors, some of whom at least seem to be very respectable (though not ‘orthomolecular medicine‘, which is a cult founded on the batty late-life beliefs of the once great Linus Pauling that Vitamin C is a magic bullet).
Furthermore they are thanked thus
As it happens, David Smith is an old friend, so I wrote to him, and also to Philip Cowen, with some detailed questions. I didn’t get detailed answers, but the responses were none the less interesting. Cowen said
“I did see the report and quite agree with your conclusions that it an observational study and therefore not informative about causality.”
“The advice about diet seems reasonable although, as you point out, probably somewhat redundant.”
But still more interesting, David Smith told me (my emphasis)
“the survey was the largest of its kind and was done on minimal funding; hence several matters could not be dealt with and so the report is more hypothesis-generating for future research than a rigorous scientific study. Find us some money and we will do a proper job. You can quote me for that, if you wish.”
I’d grateful to David for his permission to quote this comment, It seems that Holford’s top scientific advisor agrees that it is not a rigorous study, and even agrees that the “proper job” is still to be done.
But it does seem a shame that that was not made clear in the report itself.
This is the first of a several posts that have arisen from a visit to North America. One thing that the trip led to was an interest in how HR departments influence science -if you have a story about that, please email me.
Following the media publicity that surrounded the lecture in Toronto, I was sent this poem by Anne Spencer, of Canada.
It is based on the style of Jonathan Swift (1667-1745), and she had earlier went a more political version, below, which was a runner up in the international Swift satire poetry competition, 2004. Anne Spencer has been kind enough to let me reproduce both her poems here.
What men wish, they like to believe.
Julius Caesar
Verses on folly, faith and fantasy
Great Caesar saw what we still find
In much of modern humankind,
That wishful thinking will suppress
The reason we should all possess.
Take health. That is a main concern.
We look for cures at every turn
For sicknesses that cause unease
And nasty things that bring disease.
But from the science of the age
Too many now will disengage,
Forget the studies, evidence
Of remedies that will dispense
A tested way of healing those
Conditions doctors diagnose.
They say they’ve lost their confidence
In science, and have a preference
For substances that they perceive
Fit in with what they all believe
In nature’s realm of field and flowers,
Along with supernatural powers
Or energies that ebb and flow
And are released by those who know
The proper touch or breath or spell
For proper paying clientele.
And other forms of therapy
Like healing touch they all agree
Despite their failure to explain
Result in easing of their pain.
For grave conditions that could kill
It’s nature’s bounty fills the bill,
From goats a serum crushes AIDS
And grape juice makes Altzheimers fade,
Red clover makes the blood come clean
And sugar pills become routine
As remedies for things they feel
They cannot count on science to heal.
And substances that they produce
To cure complaints or pain reduce
They say they must dilute and then
Dilute, dilute, dilute again
Because the less you have, not more
Will guarantee a better cure.
(Conclusions such as this imply
There’s no attempt to reason why.)
And quite impervious they stay
To anything their critics say
About placebos and effects
That challenge rational intellects.
Their gurus sanction their belief
That things they give them bring relief
From anything they want to try,
(Because the more they wish, they buy)
If people give them hope and say
That black is white, then that’s OK.
But there’s the rub – for harm can come
By seeing this as rule of thumb
For if you disregard the facts
That science tells, then this detracts
From treatments that show evidence
Of beneficial consequence.
More harm than good can come to those
Rejecting treatments that propose
Results that doctors can compile
Which don’t depend upon a smile
Or harmony with sundry forces
Brought to bear by doubtful sources.
So those who wish upon a star
Or herb or potion in a jar
To grant relief from ache or pain
Could well decide to think again
And weigh the chances that desire
Not reason is what we require
To make us well when we succumb
To ailments that are troublesome.
For wishful thoughts beguile the mind
But leave reality behind.
And here is the political version of Anne Spence’s poem
Great Caesar, famed in Gallic wars,
A champion of the Roman cause,
Who came, and saw and conquered when
The sword was mightier than the pen,
Was yet a statesman, author, who
Knew much of human nature too.
For Caesar saw what we still find
In much of modern humankind,
That wishful thinking reason dims
And validates our selfish whims.
But more we see in public spheres
How much this maxim oft appears,
To show how leaders are consumed
By things believed their wish presumed.
And lately this seems quite okay
With rulers of the USA.
(But we, like Swift, will make our claim
By ‘lashing vice’ but sparing name).
With politics that are complex
Illusions tend to blur the specs
When men believe whate’er they wish
Some policies get devilish.
And when you add religion too
We have a complicated brew,
And here a leader we can see
Who joins the ruling company
Of men who demonstrate the state
Of those who wish with truth equate.
He left a weak addicted past
To seek his destiny at last.
Became a Christian, born again
Aspiring to a higher plane.
(Genetically he was ahead
Since daddy had the nation led.)
But, once elected by a fluke,
(That all just men would sure rebuke)
He saw his mission godly sent
To show the world enlightenment.
And he believed that evil dwelt
Within an oil producing belt,
Its ruler evil incarnate
A tyrant quite degenerate.
And so when terrorists attacked
The World Trade towers, this proved the fact,
Or so he said, for who could not
Connect events with dot to dot?
He’d purge the world of evil’s stain
In person of Saddam Hussein.
He would not shrink from duty’s call
To seek Saddam’s decline and fall,
For he believed his destiny
Proclaimed by God – Divine decree.
He’d find the hidden weapons and
He’d bring new freedom to the land
Where western values were deplored
By villains who lived by the sword
(Or torture, rape, or nasty gases
With which they murdered ethnic masses).
And so he would avenge the dead,
Depose the tyrant, and instead
Lead on his troops –at least he’d send
Them forth to bring about this end.
God chose him evil to despoil
(And as reward he’d get the oil).
Despite the cautions he received
He was inspired, he still believed
His mission was to crush this foe
Both God and Tony told him so.
So off to conquer all that’s bad
The forces left to bomb Baghdad.
Their leader stayed at home to see
How his crusade looked on tv.
The mighty tanks, the skies aflame
Were better than a video game.
The statues fell, the prisoners freed
The regime’s downfall guaranteed
The patriot missiles, patriot men
Would soon, he thought, be home again.
Though some had breathed their final breath
The ‘victory’ justified their death
And they’d be heroes ever more
While blest upon another shore.
They played their part, they fought the fight,
Their president bid them goodnight.
They left behind a populace
Who now could western life embrace.
Well, most of it – religiously
They kept their views on sanctity.
Their heaven, they said, was nicer, and
They could have virgins on demand.
(It seems this wish- belief thing will
For any culture fill the bill).
But though the war, it seemed, was won
The problems only had begun.
The leader’s view that freedom would
Make people act the way they should
Once out from under evil’s thrall,
It turned out didn’t work at all.
Because he’d only wished , not thought
Things through with wisdom as he ought,
The leader found his plans rejected
Much more than he had once expected.
His mandate from his holy source
Was not so easy to enforce.
His ignorance of tribal clans,
Of loyalties and partisans,
Reliance on intelligence
Which didn’t make a lot of sense,
Attending to his favourites
And lots of other deficits,
Caused wild confusion in the land
So hard for him to understand.
The law and order that he craved,
Now he’d removed the ones depraved
Was not forthcoming, but instead
A lot more people ended dead.
But still he had to carry on,
With pressure from the Pentagon,
Because he thought and wished it so
That God would help him beat the foe,
Despite continual loss of life
Of those confronting all the strife.
But strange! His enemies were sure
That Allah would their cause secure.
So God to God and wish to wish
The conflict grew more feverish.
And back at home the leader found
Himself on much more shaky ground,
And world opinion, never sure
He really had the grounds for war
Began to further criticize
His too aggressive enterprise.
(As still ongoing was the strife
With still ongoing loss of life).
And God and Allah seem, to date,
Not sure which side to vindicate.
And so men’s own reality
Ignores that it’s their vanity
That is at root the primal cause.
This makes us think and gives us pause.
For men in highest places show
How vain beliefs can bring us low.
And those our leaders who are prone
To wish for things we can’t condone,
Believing they are in the right,
Might look up at the sky at night.
To wish upon a star is nice
Less likely to elicit vice,
Corrupt belief and common sense
Or make ambition too intense.
(And Judy Garland did endorse
The great celestial resource)
But when as president they act
They’d better base beliefs on fact.
The truth will out, and leaders who
Ignore it, they should exit too.
As I have often said, you don’t need to be a scientist to see that most alternative medicine is bunk, though it is bunk that is supported and propagated by an enormously wealthy industry..
There were two good examples this week, John Sutherland, who was until recently professor of English literature at UCL, understands it very well. And so does political columnist, Polly Toynbee.
“Complementary and Natural Healthcare Council”
Polly Toynbee’s column, “Quackery and superstition – available soon on the NHS“, was prompted by the announcement in The Times that the government was to set up a “Natural Healthcare Council”. It was soon renamed the “Complementary and Natural Healthcare Council” (CNHC) It was instantly dubbed ‘OfQuack’ in an admirable analysis by quackometer.a>
The very name is tendentious and offensive to any thinking person. What is “natural” about sticking needles in yourself, or taking homeopathic polonium?
Toynbee comments
“Put not your trust in princes, especially not princes who talk to plants. But that’s what the government has decided to do. The Department of Health has funded the Prince of Wales Foundation for Integrated Healthcare to set up the Natural Healthcare Council to regulate 12 alternative therapies, such as aromatherapy, reflexology and homeopathy. Modelled on the General Medical Council, it has the power to strike therapists off for malpractice.”
There was only one thing wrong in this article. Toynbee says
“The alternative lobby replies that conventional medicine can also do more harm than good. They chortle with glee at an article in the Lancet suggesting there is no scientific evidence for the efficacy of 46% of conventional NHS treatments. But that’s no reason to encourage more of it.”
Professor John Garrow has pointed out (see, also Healthwatch )
“It is true they chortle, but they have got their facts wrong. The 46% of treatments which are not proven to be effective is 46% of all treatments for 240 common conditions – and very few are used in the NHS. The great majority are treatments used by alternative practitioners. “
The unconstitutional interference by the Prince of Wales in public affairs has been noted often before, and it seems that it’s happening again.
For example, there is the TV programme, “Charles, the Meddling Prince”, or, for a US view, see “Homeopathy: Holmes, Hogwarts, and the Prince of Wales“. And then there’s Michael Baum’s superb “An open letter to the Prince of Wales: with respect, your highness, you’ve got it wrong“.
It isn’t that regulation isn’t needed, but that the sort of regulation being proposed won’t do the trick. The framework for the “Natural Healthcare Council” has been set up by Professor Dame Joan Higgins, and it seems to be very much along the lines proposed by the Prince of Wales. Here’s what’s wrong.
| Professor Dame Joan Higgins (Jan 10th) says “Complementary therapists have been in practice for many years” and “If complementary therapy is not to be banned, is it not, therefore, wise to regulate it and offer the public some measure of protection”. That’s fine, but I think the sort of regulation that she, and the Prince of Wales, are proposing won’t do the trick. We don’t need new laws, or new quangos, just the even-handed application of existing laws. Homeopathic arnica 30C contains no arnica, and one would expect that the Office of Fair Trading would have banned it. It is no different from selling strawberry jam that contains no strawberries. But absurd legal loopholes make homeopaths immune to prosecution for this obvious mislabeling, whereas jam fraudsters would be in deep trouble. The Advertising Standards Authority, likewise, is prevented from doing its job by legal loopholes, and by the fact that it has no jurisdiction over web advertising, which is now the main source of untrue claims. If alternative medicine advocates had to obey the same laws as the rest of us, the public would be better protected from fraud and delusion. What won’t work is to insist that homeopaths are “properly trained”. If one takes the view that medicines that contain no medicine can’t work, then years of being trained to say that they do work, and years spent memorizing the early 19th century mumbo-jumbo of homeopathy, does not protect the public, it imperils them. |
The “Natural Healthcare Council” isn’t the only example either. Try Skills for Health.
Skills for Health
This appears to be a vast bureaucratic enterprise devoted to HR-style box-ticking. Just in case you don’t know about this latest bit of HR jargon, there is a flash movie that explains all.
“Competences are descriptors of the performance criteria, knowledge and understanding that are required to undertake work activities. They describe what individuals need to do, and to know, to carry out the activity -regardless of who performs it.”
That sounds OK until you realise that no attention whatsoever is paid to the little problem of whether the “knowledge and understanding” are pure gobbledygook or not. It’s rather like the HR form that ensures UCLH that you are a fully-qualified spiritual healer “Laying on of hands: just tick the box“.
It is an invidious insult to human intelligence to suppose that exercises like this are an appropriate way to select people for jobs. They have precisely the opposite effect to that intended.
An indication of the level of their critical thinking is provided what is written about the 62 items listed under “Complementary Medicine” These include “CHH5 Provide Healing”.
“This workforce competence is applicable to:
- healing in the presence of the client
- distant healing in contact with the client
- distant healing not in contact with the client
Both healing in the presence of the client and distant healing use exactly the same mental and spiritual processes. Clearly, however, distant healing does not involve many of the physical aspects of healing in the presence of the client. The performance criteria have been written so as to be able to be interpreted for use in any healing situation.
The workforce competence links to CHH6 which is about evaluating the effectiveness of the healing.”
It also includes homeopathy, for example “HM_2: Plan, prescribe and review homeopathic treatment“.
I sent an email to Skills for Health to ask who wrote this stuff. A reply from their Technical Development Director failed to elicit any names.
| We develop competences to fit sector needs and demands. When that need is moved into a competence project we establish a number of groups from the specific area to work with us to develop the competences. One of these groups is a “reference” group which is made up of experts from the field. In effect these experts give us the content of the competences, we write them in our format. So I guess the answer as to who is the author is Skills For Health, but with more complexity behind statement.Please do not hesitate to get in touch with me for further clarity. |
A conversation with Skills for Health
I did want more clarity, so I phoned Skills for Health. Here are some extracts from what I was told.
“It’s not quite as simple as that”
“the competencies on our data base are written by “experts in the field”
DC. Yes and it is their names that I was asking for
“I’m not sure I can give you the names . . . We’re starting to review them in the New Year. Those competencies are around six years old. ”
“We are working with the Prince’s Foundation for Integrated Health [FIH] via Ian Cambray-Smith to review these competencies, all the complementary therapy competences on our web site”
“They are written as a consensus decision across a wide number of stakeholders across that area of …”
DC. Written by whom though?
“written by a member of Skills for Health staff or a contractor that we employ simply to write them, and the writing is a collation of information rather than their original thoughts, if you like”
DC yes, I still think the sources can and should be given.
“FIH didn’t spend any money with us on this project. This project was funded by the Education act regulatory bodies, QCA, the Qualifications and Curriculum Authority . . . ”
“They [FIH] may well have put in and supported members of their professions or groups to do part of this . . they were there as experts on that particular area of complementary therapy ”
DC it’s their names that I was after
“There may well have been members [of FIH] on the reference groups that I’ve referreed to who are members of the FiH . . .they were there as experts from that area of complementary therapies.”
DC Oh, and are the names of [the people on] these reference groups published?
“No they are not published”
DC ah, why not?
“We do not consider it necessary”
DC Well, I consider it very necessary myself
“Tell me why”
DC It’s a question of public accountability
“I guess the accountability lies with us as the owners of those competencies”
DC Uh I’m afraid your bureaucratic jargon is a bit much for me there. “The owners of those competencies”? I’m not sure what that means
“Why do you want the information?”
DC haha, well if you want me to be entirely blunt, it’s because I’m appalled that this black magic is appearing on a government web site
“. . . can I say that as an organisation funded by a number of sources, one being Department of Health England, none of our work condones the practice you’ve just suggested. Our work supports best practice in areas that are evidence- and research-based”
DC Ah would you mind pointing me to the evidence for homeopathy and distant healing?
“Uh [pause] there is [pause]”
DC Yes, go on
“Well homeopathy is a contentious issue, because every newspaper article I read seems to suggest that homeopathy, in itself, is not an appropriate, uh, not an, uhm, appropriate, uh, therapy.”
DC Yes so why are you laying down standards in it?. You know I’m curious. I’m genuinely curious about this
“The areas involved in them have asked us to, including the Prince’s Trust hence the reason we are doing . . .”
DC But the Prince’s Trust is not part of government. Ha, it behaves as though it was , I agree, sometimes but it is surely for the Department of Health to ask you to do these things, not the Prince of Wales.
“We cover the whole health sector.. We don’t purely work for, or are an organisation of, the Department of Health.”
DC. I’m very baffled by the fact that you say, you very accurately the research on homeopathy, namely that it doesn’t work, but you are still setting standards for it. It’s quite baffling to me.
“Working with the Foundation for Integrated Health, as we are doing, homeopathy is one of the 10 areas that is listed for regulation by FIH ”
DC. Well yes the Prince of Wales would like that. His views on medicine are well known, and they are nothing if not bizarre. Haha are you going to have competencies in talking to trees perhaps?
“You’d have to talk to LANTRA, the land-based organisation for that.”
DC. I’m sorry, I have to talk to whom?
“LANTRA which is the sector council for the land-based industries uh, sector, not with us sorry . . . areas such as horticulture etc.”
DC. We are talking about medicine aren’t we? Not horticulture.
“You just gave me an example of talking to trees, that’s outside our remit ”
After explaining that talking to trees was a joke, the conversation continued
DC So can I clarify then? Who is it that said you must include these fairly bizarre things like distance healing and homeopathy? Who decides whether it goes in?
“We did”
“We are going to do a major review. We are doing that review in partnership with the FiH and the awarding bodies that award the qualifications that are developed from these competencies”
“When that need is moved into a competence project we establish a number of groups from the specific area to work with us to develop the competences. One of these groups is a “reference” group which is made up of experts from the field. In effect these experts give us the content of the competences, we write them in our format.”
Conclusions from this dialogue
We still don’t know the names of the people who wrote the stuff, but a Freedom of Information Act request has been submitted to find out
The Skills for Health spokesperson seems to a a bit short of a sense of humour when it comes to talking to trees.
The statement that “Our work supports best practice in areas that are evidence- and research-based” is not true, and when pressed the spokesperson more or less admitted as much.
Most importantly, though, we do now know that the revision of this gobbledygook will be carried out entirely by the Prince’s Foundation for Integrated Health and the people who set exams in the relevant form of gobbledygook. No critical voice will have an input, so don’t expect much improvement. “We are working with the Prince’s Foundation for Integrated Health [FIH] via Ian Cambray-Smith to review these competencies”. And in case you don’t know about the medical expertise of Ian Cambray-Smith, it is described on the FIH web site. He is the FIH’s Health Professionals Manager.
 |
Ian Cambray-Smith acts as the focus for FIH’s involvement with healthcare professionals. He works collaboratively to develop a range of work programmes, policies and initiatives to support healthcare professionals and help them to deliver a truly integrated approach to health. Ian’s background is in plastics research, project management and business development; he has an MSc in polymer technology. He joined the Foundation in 2006. |
Happy new year. not least to the folks at the homeopathy4health site . They are jubilant about a “proof” that homeopathic dilutions could produce effects. albeit only on wheat seedlings. But guess what? After some questioning it was found that they hadn’t actually read the paper. Well I have read it, and this is the result.
The paper is “A Biostatistical Insight into the As2O3 High Dilution Effects on the Rate and Variability of Wheat Seedling Growth”. Brizzi,
Lazzarato, Nani, Borghini, Peruzzi and Betti, Forsch Komplementärmed Klass Naturheilkd 2005;12:277–283
The authors compared these treatments (30 seedlings each).
- C1, C2, C3 (untreated water p.a. Merck, control);
- WP (potentized water p.A. Merck) 5x, 15x, 25x, 35x, 45x;
- AD (diluted arsenic trioxide) 10–5, 10–15, 10–25, 10–35, 10–45;
- AP (potentized arsenic trioxide) 5x, 15x, 25x, 35x, 45x.
The allocation of seedlings to treatments was stated to be blind and randomised. So far, so good.
But just look at the results in Figure 1. They are all over the place, with no obvious trend as ‘potency’ (i.e. dilution) is increased. The
results with homeopathic arsenic at 45 days (the only effect that is claimed to be real) is very little different from the that of shaken water (water that has been though the same process but with no arsenic present initially).
For some (unstated) reason the points have no standard errors on them. Using the values given in Table 3 I reckon that the observation for AP45 is 1.33 ± 0.62 and for the plain water (WP45). it is 1.05 ± 0.69. The authors claim (Table 3) that the former is ‘significant’ (with a profoundly unimpressive P = 0.04) and the latter isn’t. I can’t say that I’m convinced, and in any case, even if the effect were real, it would be tiny.
Later the authors do two things that are a very dubious from the statistical point of view. First they plot cumulative distributions which are notoriously misleading about precision (because the data in adjacent bins are almost the same). They then do some quite improper data snooping by testing only the half of the results that came out lowest. If this were legitimate (it isn’t) the results would be even worse for homeopaths, because the difference between the controls and plain water (WP45) now, they claim, comes out “significant”.
Homeopaths claim that the smaller the dose, the bigger the effect (so better water down your beer as much as possible, making sure to bang the glass on the bar to potentise it). I have yet to see any dose-response curve that has the claimed negative slope. Figure 1 most certainly doesn’t show it.
Of course there is no surprise at all for non-homeopaths in the discovery that arsenic 45x is indistinguishable from water 45x.
That is what we have been saying all along.
We hear a lot about leadership these days. It has become one of the favourite buzzwords of those who do neither research not teaching. The word occurred six times in a recent HR-speak document that was sent to explain the criteria for promotion to a chair. Quite what it means is never clear. Could it just be a talent for telling other people to do things that the leader can’t do himself? (People who describe themselves as leaders are, needless to say, mostly male.) Only too often those who call themselves ‘leaders’ turn out to be suffering from the Siegfried delusion -in the words of Ernest Newman, overgrown boy scouts.
One thing that leadership certainly should include is setting a good example in ethical behaviour. So what’s going wrong?
We’ve seen the case of Howard Newby. We’ve seen vice-chancellors (12 of them) refuse point blank to respond to enquiries about how they justify running degrees in alternative quackery, despite the fact that even the Queen’s Homeopathic physician thinks it is unjustified to run BSc degrees in homeopathy (watch him say so).
We’ve seen the malign influence of corporate money (most strikingly in the UK in the notorious case of the University of Sheffield). We have seen ghost-writing and spin tolerated, and even encouraged, not to mention sham consultations and attempts to impose the Wal-Mart values of PricewaterhouseCooper on research.
Here are two more interesting examples of ‘leadership’.
Professor Sir Roy Anderson
| Next year, the rector of Imperial, Richard Sykes, will be replaced by Roy Anderson, epidemiologist and Chief Scientific Adviser to the UK Ministry of Defence,. Sykes is the chap who (with a little help from my first attempt at a web campaign) failed in his messianic attempt to take over UCL in 2002. |  |
Imperial rector with a past
In June this year, Imperial College London announced that Roy Anderson, a distinguished epidemiologist and former chief scientific adviser to the MoD, would succeed Richard Sykes to become rector next year. An internationally renowned academic and researcher, Anderson is amply qualified for this ambassadorial role in the British scientific establishment. Yet some, including the former director of the Wellcome Trust, Bridget Ogilvie, have remarked to Prospect that parts of the scientific community were “very surprised” at Anderson’s selection in view of the controversies seven years ago that surrounded his professorship at Oxford.
The first scandal arose when Anderson accused a female colleague of having won support for her post via a relationship with her head of department—a claim he was eventually forced to retract as untrue, and which was a major factor in his subsequent resignation from Oxford. At around the same time, Anderson’s resignation from the board of the Wellcome Trust was announced, prompted in part by his failure fully to disclose his relationship with a private biomedical consultancy during his time at Oxford, in breach of the trust’s financial guidelines.
It should, of course, be emphasised that Anderson did nothing illegal; he has always been admired as a dynamic leader, and some feel that the “Oxford scandals” can now be set aside as isolated incidents in an otherwise unblemished career. It will be interesting to see what he makes of his new position.
And this appeared in Nature June 2000. [Download ‘A Question of Trust’] .
But perhaps most damaging was the downfall of Roy Anderson, a leading epidemiologist, and one of the governors who run the trust. Anderson, who also directed the Wellcome Trust Centre for the Epidemiology of Infectious Diseases at Oxford University, was forced to resign from the university, the centre and as a trust governor, following the publication of two damning reports into his management of the Oxford centre. Initially triggered by allegations that Anderson had made sexual slurs against a female colleague chosen for a senior position at Oxford, the investigations went on to examine his failure fully to disclose business interests that had become entangled with the Wellcome centre’s research activities.
There is more comment in Nature 404, 802; 2000 [download pdf] , and “Director of Wellcome centre resigns over damning report” Nature 404, 696; 2000 [download pdf]
A lot of people seem to be quite puzzled by Imperial’s choice of leader.
Sir John Chisholm
| Mild surprise greeted the news that the chairman of the Medical Research Council (MRC), John Chisholm, is also Executive Chairman and former Chief Executive of QinetiQ (the privatised version of the UK Ministry of Defence’s Defence Evaluation and Research Agency). Was this sort of some job creation scheme? The arms merchants providing customers for the health service? |  |
The Parliamentary science and technology committee, certainly had reservations (“New medical research chair unfit for job, say MPs“).
An editorial in the British Medical Journal (March 2007) commented on this unholy mix, thus.
“In a recent editorial in the Journal of the Royal Society of Medicine, Richard Smith drew attention once again to the paradoxical and disturbing association between Reed Elsevier, a huge global publishing company, and the international arms trade.1 While promoting world health through its publications, including the Lancet, Reed Elsevier also organises international trade fairs for the arms industry. By facilitating the sale of armaments, Reed Elsevier is directly implicated in causing untold damage to health.”
In March 2007. Nature commented
“The MRC faces other challenges, too. Last October saw its appointment of a chair, John Chisholm, who has a strong track record in privatizing defence research laboratories. He has recently sent signals that have left MRC researchers dumbfounded. To judge by recent statements, he views biomedical research as being applied research by definition, and sees fundamental research to be all but irrelevant.”
According to a report from the National Audit Office, the Treasury sold off its arms research to the US private equiry group far too cheaply. A handful of directors made staggering personal fortunes from the deal. This interchange occurred in the minutes of evidence to the Committee of Public Accounts (Monday 3 November 2007). The chairman was Edward Leigh (Conservative MP for Gainsborough).
Q18 Chairman: Yes, because you told the Defence Committee on 28 February 2001: “In regard to people who were already in the organisation, certainly when they have proved themselves successful they can expect to earn a reward but they cannot expect to earn it just because we have been privatised”.
What the public think is that it is frankly appalling. It goes totally against any concept of ethical capitalism, Sir John, that you can put £100,000 into a business and emerge with £25 million of taxpayer’s money. Nobody from outside can understand it. Do you have any sense of shame here before us?Sir John Chisholm: I have a considerable sense of having led a team to create £1 billion worth of value for the taxpayer. I think that is a great achievement by the team.
Q19 Chairman: Why should your poor staff get £9 for every pound they put in but you get £200 for every pound that you put in? Do you think that is fair?
Sir John Chisholm: I believe in any deal like this there was a contractual agreement put by the investor to the management team that had considerable risk for the management team at the time and they signed up to it.
. . . .
Q30 Mr Touhig (Lab,Islwyn): You see our concern, because one of the first things that Carlyle did when it became the preferred bidder was to change the planned management incentive scheme following representations from the QinetiQ Board. The outcome of this, as the Chairman has pointed out, was that top management got almost a 20000% increase on the return on their investment. Sir John, that is not so much the unacceptable face of capitalism as the unacceptable face of greed, is it not?
Sir John Chisholm: I do not accept that, no.
So not much concern for “ethical capitalism” there.
Is this what we are meant to learn on the ‘leadership’ courses that are springing up everywhere?
Is this the sort of example to set to young scientists about how to succeed?
Is this how to get good science?
I think not.
Postscript
From Private Eye 26 January 2008.
| NUMBER CRUNCHING £100m. Profits gained by senior executives through QinetiQ privatisation £75m. QinetiQ pension deficit, now being addressed by additional staff contributions. |
The Times Higher Education Supplement (THES) last week had a headline “Staff loyalty key to Hefce report”.
Staff loyalty is something I’m interested in, so I read on eagerly.
The article was about report from the Higher Education Funding Council for England (HEFCE). It came from their Leadership, Governance and Management Strategic Advisory Committee (dated 2-3 July 2007). [Download the report: Word format]
Well there is the first cringe already. Whenever you see the word ‘leadership’ you can bet that it means that you are going to be lectured on how to do your job by somebody who has never done it themselves. (probably somebody suffering from Siegfried delusions -in the words of Ernest Newman. an overgrown boy scout).
| No disappointment on that score. This particular sermon is being delivered not by a successful researcher. Not even by an unsuccessful researcher who has been moved up to manage the successful ones. It is being given by Ed Smith, Global Chief Operating Officer and Strategy Leader for Assurance, PricewaterhouseCoopers. |  |
Their web site says of Ed Smith:
“He is a leading advocate of, and external speaker on People management in organisations, in particular diversity and work/life having led PwC’s own enlightenment in this area “
“PwC’s own enlightenment” ? Cringe!. Who writes this stuff, one wonders,
Here are the main points.
“3. There are high level activities to be undertaken of reconceptualising the university and rethinking the business model.”
Reconceptualise? Is it a condition of essential condition of working for PricewaterhouseCoopers to be unable to write plain English?
More to the point, one would be interested to know what concept of a university he has in mind? The statement as it stands has roughly zero content.
“4. To implement the outcome of this rethinking, there will need to be significant culture change. HEIs’ staff will need to be more aware of and aligned to the strategic needs of the HEI.
Academics’ goals are often related to their discipline rather than their institution and they will need to develop institutional loyalties in addition to discipline loyalties. Corporate planning processes will need to be communicated more effectively for those processes to be more successful. “
This statement fails to make the important distinction between the Institution itself, and the people who, for the time being, are running it (see Letters). The first thought that comes to mind after reading this is that it is a statement that is likely to have exactly the opposite effect from that intended by the writer. The more statements like this that come from on high, the less inclined people are to feel allegiance to the institution that issues them, or, to be more precise, the people who are running the institution for the time being.
Respect has to be earned.
“5. HE staff can find themselves uncertain about their role, typically
because it has never been fully made clear. Research has often become too prominent as an indicator of performance, because it has been measured in the RAE, and other activity has not been equally recognised and rewarded. “
Aha, now does that mean that our role is not to do research and teaching after all? Perhaps it has now been redefined somehow? Perhaps our role now is to waste time on sham consultations, read reams of world-class policy bollocks, and do what one is told by some official in HR? I don’t think so. The second sentence has some justice, but I guess Mr Smith has not had to suffer floods of contradictory instructions from the endlessly-multiplying ‘managers’.
One day a ‘manager’ says we must all publish three papers a year, and they must all be in the same handful of journals (though there has not, as far as I know, been
the sort of crude bullying about this at UCL that I have heard about in, say Imperial and a few other places). Furthermore we mustn’t collaborate with anyone in the same place because the same paper must not appear to the RAE to come from two groups.
The next day we will be told that the entire place must be turned upside down because of the absolute necessity for collaborations. Of course the measures that are proposed never have the slightest effect on collaboration, because they come from people who talk about it, not from people who do it.
And the next day we are told by a third person that all of the above is secondary and that teaching matters more than anything else.
Of course all these contradictory instructions do nothing but prevent us doing the research and teaching that we had supposed to be our job.
“7. HEIs will need to develop their business process and become more efficient, so that they can re-invest. The Committee advises that HEIs should not be afraid of the language and culture of business. “
The language of business, at least of the sort that now permeates universities, is usually both vacuous and pretentious. The culture of business is what produces BSc degrees in anti-science (not to mention accounting scandals).
The use of the word “afraid” in this context is sheer overweening arrogance. I have spent a lifetime trying to express complicated ideas in simple language. That seems to me to be as desirable in real science as it is in my attempts to improve public understanding of science. The aim of managers seems often to be to express
simple ideas in complicated language. I’m never quite sure whether the reason for this is illiteracy. or a conscious effort to disguise the emptiness of the ideas. A bit of both, I expect.
What do we conclude from this?
The interesting thing about this document is that it is written by a businessman but appears to me to ignore two basic business principles that can be put in perfectly simple language.
(1) Supply and demand. There will always be an endless supply of managers and pensioned-off researchers who are willing to accept professorial salaries for producing reams of policy bollocks. There isn’t even much shortage of people who can do a tolerable job of teaching at least at first or second year level. The really scarce people are the top flight original researchers, the ones who will make a difference to the future. It follows that these people have enormous power (though often they are too busy to use it). If the place that they works adopts the culture of managerialism, they will just leave Highly original minds have a low tolerance for policy bollocks. Of course this is a slow process. It might take a decade or more to destroy a good research outfit in this way, and by the time managers notice the consequences of their actions it would already be too late. It is much easier to destroy than to build.
(2) The value of brand names . This is where it gets personal, though I imagine many other people have had similar experiences in recent years. The Pharmacology Department at UCL has had a distinguished history for 100 years. I can’t count the number of times that I’ve been at meetings and heard people say “gosh you are from Pharmacology at UCL -that’s impressive”. People in the department got a glow from comments like that. That is what generated loyalty to the department and to the College that houses it. Now we are told that we are to be part of an over sized monstrosity called the “Research department of Neuroscience, Physiology and Pharmacology”. That really trips off the tongue, right? One can’t imagine something with an utterly unmemorable name like that ever getting an international reputation. In any case, I expect that another policy wonk will come along and change the name again in 5 year’s time,
How does this sort of vandalism happen? I guess one reason is that the sort of people who get to be managers just aren’t sufficiently in contact with science to be aware of the reputation that we used to have. They seem to be unaware that the reputation of an institution is no more than the sum of the reputations of the researchers and teachers who work in it (not the administrators). And if a department has a few good people in it over a long period, the department as a whole contributes too. The College reputation barely exists in isolation, just the sume of individuals. Take an example. At UCL we have an excellent department of German, a department that contributes to the reputation of UCL. But of course not one pharmacologist in a million has heard of it, just as I imagine not one German historian in a million has heard of our (late) pharmacology department.
Let’s get a few things clear.
- The job of universities is to do teaching and research.
- The teaching is enormously important but the external reputation of the establishment will inevitably depend almost entirely on its research.
- The success of the place therefore depends entirely on the people who do the research and teaching. Everybody else, from junior technician to vice chancellor is there only to support them.
- The people who do the research and teaching are the only ones who know how to make a success of those jobs The HR department, for example, know nothing about either either teaching or research. How could they? They have never done either. Their job is to make sure people get paid, not to bully and harass the people doing the real work of the university.
- The aims of business are, in some ways, precisely the opposite of those of universities. Business aims to sell things. Spin and mendacious advertising are an accepted part of the game. The tendency for them to become part of the game in universities too can do nothing but harm. Are universities mean to admire the mentality that gave rise to Enron and Worldcom?
- Remember the words of Robert May (President of the Royal Society, 2000 – 2005).
“A rather different issue that has emerged during the Blair decade is the tendency to invite people from the world of business to advise on the management of universities, or to head them. Given that UK universities still stand significantly higher on international league tables than does most of the UK business sector, this seems odd.”
On ‘leadership’ and ‘vision’.
The two most overworked words in management-speak remind me inexorably of the rhetoric used by those who advocated the merger of UCL and Imperial. And of two comments that appeared in the financial (not the academic) press after the attempt crumbled.
Lessons of a failed merger (Matthew Lynn, Bloomberg News. 20-Nov-02). “: [get the pdf].
“Unfortunately for Sykes, the professors of Imperial and University College London were smarter than the last recipients of his strategic wisdom, the shareholders in the formerly independent drug companies Glaxo Wellcome and SmithKline Beecham.
The biggest universities in the world are clearly not the best. So why do some British universities think that mergers will make them world class? (John Kay, 21-Nov-02 Financial Times).
” The same empty phrases that were used in the 1990s to justify corporate mergers are today used to justify university mergers – the aspiration to be a “global player”, the need to achieve “critical mass”. But greater size is always the aspiration of those with no better strategic vision.”
Two letters
These two responses appeared in THES the following week (Dec 7th), from opposite ends of the age spectrum. Notice that the younger one does not dare to give a name. I don’t blame him or her. That is the rule rather than the exception, when people feel intimidated. Exactly the same thing happened when the crazy “vision” of merging Imperial and UCL was on the cards. Anyone with half a brain could see it was nuts (with the exception of the senior management team at the time), but not everyone dared to say so.
| Loyalty, but not blind allegiance 1 Research associate, Russell Group university Published: 07 December 2007 Loyalty cuts both ways (“Staff loyalty key to Hefce report”, November 30). Look at contract research staff such as myself who are forced to seek employment in other institutions and environments. I cannot say that I have had an experience in my institution that inspires anything like loyalty. People there want it to go only one way. When are we going to get loyalty from our employing institutions rather than being treated as disposable drones? Research associate, Russell Group university. |
| Loyalty, but not blind allegiance 3 Geoffrey Alderman Published: 07 December 2007 Many years ago, it fell to me to chair Higher Education Funding Council for England teaching-quality inspections of academic departments. At one such event, the head of department confided to me and my team that he and his team completely disagreed with the strategic direction in which their vice-chancellor was taking them and were doing all they could to undermine it, in the interests of the discipline they taught. We agreed, and gave the department top marks. Geoffrey Alderman, Michael Gross professor of politics and contemporary history Buckingham University. |
Postscript
How very nice to get an endorsement from a Nobel prizewinner. Why, I wonder, was he not asked for his opinion about how to get good science. Perhaps PricewaterhouseCooper know better
The press releases (STOP PRESS)
Uhuh, here we go again.
All over the media we see headlines like “Honey ‘beats cough medicine’ “.
Take for example, the Daily Telegraph, where Ben Farmer writes “Honey is better at treating children’s coughs than an ingredient used in many over-the-counter medicines, according to new research”.
That is NOT what the research found This is what the research paper itself says (DM refers to the standard ‘cough suppressant’ dextromethorphan, which is already known to be ineffective).
| “honey was significantly superior to no treatment for cough frequency’ DM was not better than no treatment for any outcome. Comparison of honey with DM revealed no significant differences.” |
See it? No detectable difference between honey and standard cough medicine.
Everyone in the media misinterpreted what the paper said, but at least one blogger is already on to it, with Today’s “duh” study is a honey”.
At first sight, the results seem contradictory, No difference between honey and DM, No difference between DM and ‘no treatment’. So how can honey be better than ‘no treatment’?
The study was by Ian M. Paul, MD, MSc; Jessica Beiler, MPH; Amyee McMonagle, RN; Michele L. Shaffer, PhD; Laura Duda, MD; Cheston M. Berlin Jr, MD, published in Archives of Pediatrics & Adolescent Medicine 2007, 161, 1140 – 1146.
What was done
The design of this trial was pretty good apart from one thing Three things were compared (a) buckwheat honey, (b) a standard ‘cough suppressant’, dextromethorphan in a honey-flavoured syrup that was designed to be similar to the honey (DM for short), and (c) no treatment whatsoever.
The median age of the children who completed the study was 5.2 years (range, 2.2 – 16.9 years). They all had coughs attributed to upper respiratory tract infection. Thirty-five patients received honey, 33 received DM, and 37 received no treatment.The good thing is that the treatments were allocated randomly to the children, and that the person doing the assessment didn’t know which treatment each child had received. The children didn’t know whether they were getting honey or DM either, but they DID know when they got ‘no treatment’. The trial was carried out over two days. On day one nobody got a treatment, but they filled in a survey that asked, for example, “How frequent was your child’s coughing last night”. The parent had to tick one of seven boxes, from ‘not at all’ (score zero) to ‘extremely’ (score 6). They were then given the treatment allocated to them in a brown paper bag, so the person who gave it didn’t know which it was. The patients then went home and on the next day the same survey was completed by the same parent, over the telephone.
What happened?
First look at the raw data. Here is Figure 2 from the original paper.
The charts show the results for 5 different measures of the severity of cough, and the last chart (F) shows the aggregate score for all the criteria.
The first thing to notice is that there are no error bars on these charts. In my area, at least, no journal would accept a chart like this with no indication of scatter. There is a snag, though. Each patient acts as his/her own control, and that would not be reflected properly if errors bars were calculated for the numbers plotted in Fig. 2. It would therefore have been better to have a chart in which the difference in score between day 1 and day 2 was calculated from each patient, and the size of these differences plotted, with a standard deviation of the mean to indicate the amount of scatter in the observations. I have asked Dr Paul to send me a version that indicates the scatter of the numbers in this way (but I don’t think it will come).
The second thing to notice is that there is there is quite a big difference between the score on the first day (pale columns) and on the second day (dark columns), even in the no treatment group .
Thirdly, the pale columns are all much the same. On the first day the average score was about 4 (“a lot”) though on the second day, even with no treatment, the score fell quite a lot, to something between 2 (“a little”) and 3 (“somewhat”). This is a bit baffling because no treatment was given on either day. Presumably it results from the different settings in which the survey was given, or because the kids were getting better anyway.
Fourthly, insofar as the pale columns (baseline values) are all much the same, the thing you need to concentrate on is the difference, on each chart, between the height of the dark bars, for honey, DM and no treatment. These differences are pretty small, but on all the charts, the honey score is slightly smaller than the DM score, and the DM score is slightly smaller than the ‘no treatment’ score. What are we to make of that?
Here beginneth the statistical lesson.
Because the differences are small, and the scatter is quite big, we have to ask whether the differences are just random fluctuations rather than a result of any real difference between the treatments. That means we need statistics. Here is how the statistical argument works. Put roughly, we ask “how probable is it that the observations could arise by chance”. More precisely, the question is this. If there were no difference between the treatments, what is the probability that we would observe by chance a difference as big as, or bigger than, that seen in the experiment? (You need the subjunctive mood to explain statistics -pity it’s vanishing.)
Above each chart in the Figure we see P < 0.001. This means that there is less than a one in 1000 chance of the results arising by chance. More precisely, if all three treatments (honey, DM and no treatment) were actually identical, it is very unlikely that we’d see these results. The reasonable conclusion is, therefore, that all three treatments are not identical. The problem with this argument is that it tells you nothing about where the differences lie, so it is of no help whatsoever to a patient who is trying to decide what to do about a cough. The other problem is that it includes the ‘no treatment’ group, which was not blind. Both the children and parents were well aware that no treatment was given.
The most helpful comparison is really the properly-blinded comparison between honey and DM. And when this was looked at the result was no significant differences. In other words the small differences between the heights of the dark columns for honey and DM could perfectly well have arisen by chance if honey and DM were identical in their properties.
There isn’t any reason at all to think that honey is better than the standard (but ineffective) cough medicine.
The direct comparison between DM and ‘no treatment’ also shows no significant difference. Yet there are signs of a real difference between ‘no treatment’ and honey, though only for the cough frequency, not the other four measures. The aggregate measure (F in the figure) gave P = 0.04 for the comparison, so the authors are running a risk of 1 in 25 of being wrong in claiming a real effect. Although some people seem to regard a value of P = 0.05 as indicating a real effect, the fact that you’ll make a fool of yourself 1 time in 20 by claiming a real effect when none exists has never seemed to me to be good enough odds to stake one’s reputation on.
The ‘no treatment’ group certainly has some interest, but the fact that it was not blind means that the fact that honey was marginally better than ‘no treatment’ could perfectly well mean that taking honey has a better placebo effect that doing nothing at all. It provides no evidence at all that honey has any genuine therapeutic effect. If it had, one would then have to find out if the therapeutic effect was specific to buckwheat honey, or whether any old honey would do. It could be argued that even if the effect were real rather than placebo, the size of the effect is too small to make all that effort worthwhile.
A couple more things
It is already well known, from several good studies, that DM is useless, no better than placebo. This inconvenient fact has not yet reached many places that it should have (not even mentioned on wikipedia for example), but the American Academy of Pediatrics says
“Numerous prescription and nonprescription medications are currently available for suppression of cough, a common symptom in children. Because adverse effects and overdosage associated with the administration of cough and cold preparations in children have been reported, education of patients and parents about the lack of proven antitussive effects and the potential risks of these products is needed.”
The discussion in the paper by Paul et al, seems surprisingly upbeat about honey, in the light of their own findings. I’m surprised that they use the term ‘demulcent’ which I had thought to have died out, like the word ‘tonic’, on the grounds that it had no defined meaning
It is because meaningless terms and useless medicines die out eventually that medicine makes progress. The problem with alternative medicine is that nothing dies out: on the contrary they keep adding myths.
And finally
Always look at the end of the paper. On this one we see that the study was paid for by the National Honey Board. Dr Paul assures me that the funding source had no say in the design or analysis, which is as it should be.
Financial Disclosure: Dr Paul has been a consultant to the Consumer Healthcare Products Association and McNeil Consumer Healthcare.
Funding/Support: This work was supported by an unrestricted research grant from the National Honey Board, an industry-funded agency of the US Department of Agriculture.
So what is the practical outcome?
My conclusion from all this is simple. If you have got a cough, tough luck. There isn’t really anything available, conventional or alternative, that does much good. You’ll just have to wait for it to get better. But if you want to take something that tastes nice, why not honey? It almost certainly won’t do any good but it tastes good and it’s safer than the standard cough medicine.
The sponsor’s interpretation
It seems that the sponsor of the work is happy with the misinterpretation.
Charlotte Jordan a project manager of research at the National Honey Board, believes the finding confirms what your grandmother told you.
“This is a really exciting finding,” she said. “For a long time it’s been folklore medicine to use honey when you have a cough or a cold, but it’s exciting to have a scientific study to back that up.”
Just one problem, That is NOT what the paper says.
How did all this mis-reporting happen?
One reason is misleading press releases. Universities and Academic journals now engage in shameless PR, spin and hype. They prostitute good science.
Download press releases from Penn State, JAMA and Press Association [pdf file]
Here is the highly misleading bit of hype that came from the Press Office of the Pennsylvania State University. The headline is “Honey a better option for childhood cough than OTCs” (OTC means over-the-counter medicines that contain DM). That contradicts directly the paper which says “Comparison of honey with DM revealed no significant differences”.
Likewise the statement in the Penn State release “Honey did a better job reducing the severity, frequency and bothersome nature of nighttime cough from upper respiratory infection than DM or no treatment” is equally incompatible with “Comparison of honey with DM revealed no significant differences”. Its only possible justification is from the 3 way comparison by analysis of variance and that does not tell us what we need to know.
To make matters worse, the media office is not to blame this time. Ms Manlove told me tonight that the press release had been approved by Dr Paul himself.
| Contact: Megan W. Manlove Penn State Honey a better option for childhood cough than OTCs A new study by a Penn State College of Medicine research team found that honey may offer parents an effective and safe alternative than over the counter children’s cough medicines. The study found that a small dose of buckwheat honey given before bedtime provided better relief of nighttime cough and sleep difficulty in children than no treatment or dextromethorphan (DM), a cough suppressant found in many over-the-counter cold medications. Honey did a better job reducing the severity, frequency and bothersome nature of nighttime cough from upper respiratory infection than DM or no treatment. Honey also showed a positive effect on the sleep quality of both the coughing child and the child’s parents. DM was not significantly better at alleviating symptoms than no treatment. . . . |
All that Candice Yakel, of the Office for Research Protections at Penn State had ro say in the matter was
“Our investigators stand by the conclusions of the study as reported in the Archives of Pediatric and Adolescent Medicine and as characterized in our press release of December 3, 2007.”
And here is the equally misleading bit of hype issued by the Journal of the American Medical Association (Ms Manlove tells me that this was also approved bt Dr Paul).
| JAMA and Archives Journals Study suggests honey may help relieve children’s cough, improve sleep during colds
|
The Press Association release was equally bad, and probably the one used by many of the reporters as a basis for stories in the media. The opening statement is totally wrong.
| 1 HEALTH Honey Embargoed to 2100 Monday December 3 HONEY BEST FOR KIDDIES’ COUGHS SAY RESEARCHERS By John von Radowitz, PA Science Correspondent Natural honey is a better remedy for children’s coughs than expensive over-the-counter medicines, researchers said today. A dose of buckwheat honey before bedtime easily outperformed a cough suppressant widely used in commercial treatments, a US study found. . . . |
Follow-up
There is a review of over-the-counter cough medicines in the BMJ (2002) [free full text]. It concludes “Recommendation of over the counter cough medicines to patients is not justified by current evidence”.
Jump to Times Higher Education coverage
This is a longer version of comments published in the Times Higher Education Supplement, June 1, 2007. This longer version has now been printed in full in Physiology News, 69, 12 – 14, 2007 [download the pdf version].
It has now been translated into Russian.
Download pdf version of this paper.
I should make it clear that the term ‘bean counter’ is not aimed at accountants (we need good honest accountants). Rather it is aimed at a small number of senior academics and HR people who do not understand how to assess people.
How to get good science
David Colquhoun, Department of Pharmacology, University College London (May 2007).
email me
The aim of this article is to consider how a university can achieve the best research and teaching, and the most efficient administration.
My aims, in other words, are exactly the same as every university vice-chancellor (president/rector/provost) in the country. Continue reading
One of the effects of this affair has been the posting of some critical examinations of some of the writings of Dr Ann Walker. I make no comment. The links are here.
This item appeared originally on the old IMPROBABLE SCIENCE page
The reversal of UCL’s request to remove this page from UCL’s server was, in large part, the result of the power of the blogosphere. Here are some of the things that did the trick.
“Moved to tears by the beauty of blogs”. Goldacre wraps up the affair in the Guardian, and on badscience.net (“Stifling Debate – When Bloggers Attack”).
He gives links to the close examination of the work of Dr Ann Walker that that is now appearing.
“UCL have just issued a smashing statement on Prof Colquhoun’s de-excommunication.” Comment from badscience.
This episode seems to have sparked a close inspection of some of the claims made by Ann Walker. Here are some examples.
“Dr Ann Walker and Her Neanderthal Theories”. An analysis of Walker’s theory about the Neanderthal diet, on the quackometer blog. Goldacre comments
“In one piece, Walker promotes the idea that neanderthals were not a distinct kind of human, but degenerate and malnourished versions of ordinary humans: buy pills or regress to a sub-human state, seems to be Walker’s message. Yikes.”
“Ann Walker festival: “There is no convincing evidence that Ginkgo biloba is efficacious for dementia and cognitive impairment” ” Holfordwatch takes a cool look at more claims by Ann Walker.
“Red Clover comments leave a bitter aftertaste” Click here
“The War Against Gobbledygook” Comment from Astrophysicists.
“UCL Makes good” Comment from the University of Minnesota
University Diaries. A US Professor of English reproduced Ben Goldacre’s first
article.
“Science bloggers unite” Comment from a Yale neurologist.
“The Guardian: a quackbuster . . . “ Comment from MIT (and it’s on the MIT server).
“UCL change tack: Colquhoun is back” The Sceptical Preacher speaks
Freedom of speech and litigious herbalists
Announcement 13 June 2007. UCL restores
DC’s IMPROBABLE SCIENCE page.
After taking legal advice, the provost and I have agreed a joint statememt.
Read it on the UCL web site.
“ . . . the Provost and Professor Colquhoun have taken advice from
a senior defamation Queen’s Counsel, and we are pleased to announce that Professor Colquhoun’s website – with some modifications effected by him on counsel’s advice – will shortly be restored to UCL’s servers.”
I am grateful to UCL for its legal support, and I’m very grateful too for the enormous support I’ve had from many people, especially since Ben Goldacre mentioned the site move. Now all I need is a bit of help to get it into a more convenient format. The page will stay at its present address until there is time to sort things out. For some of the fallout from these events, click here. The name of the page has been changed from quack.html to improbable.html on the advice of lawyers, but the old addresses still work.
Announcement 30 May 2007.
My item about claims made for alleged benefits of the red clover and other herbs has resulted in complaints being made to the provost of UCL (Malcolm Grant), and to Chair of Council (Lord Woolf). The complaints have come from Alan Lakin, husband of Ann Walker. I have received no complaints from them myself.
In the six or years that I have been running this attempt to improve public understanding of science, I am aware of only two serious complaints being made, and as far as I know, this is the first to reach the level of the provost. This one resulted in a request to remove of this page from the UCL server, but that is now reversed.
Two interesting papers. One shows popular anti-oxidant ‘supplements’, beta carotene, and vitamins A and D, far from making you live longer, have the opposite effect. Another shows that garlic does not lower cholesterol. And some publicity for Dan Hurley’s book, Natural Causes. An update looks at the activities of the supplements industry spokesperson. Dr Ann Walker, who seems sometimes to forget to declare her interests.
First let’s reiterate the myth of antioxidants
Nutribollocks: the antioxidant myth
“Nutritional supplements” are one of the most profitable scams (see, for example, Healthwatch, Quackwatch, and Holfordwatch).
There is a nice article by Lisa Melton on The Antioxidant Myth: a medical fairy tale in tne New Scientist (and see here), [download as pdf] . Here are some quotations.
| Cranberry capsules. Green tea extract. Effervescent vitamin C. Pomegranate concentrate. Beta carotene pills. Selenium. Grape seed extract. High-dose vitamin E. Pine bark extract. Bee spit.You name it, if it’s an antioxidant, we’ll swallow it. According to some estimates around half of US adults take antioxidant pills daily in the belief that they promote good health and stave off disease. . . . In 1992 researchers at the US National Cancer Institute set about testing beta carotene. The trial was set to run for 6 years, but two-thirds of the way through the researchers pulled the plug after discovering, to their surprise and horror, that those taking supplements were doing worse than the controls. They had developed 28 per cent more cases of lung cancer, and their overall death rate was 17 per cent higher. It’s a similar story with the world’s most popular antioxidant. Vitamin E shot to fame in the early 1990s, after two large studies involving more than 127,000 people in total found that those with a diet high in vitamin E were significantly less likely to suffer cardiovascular disease. Use of vitamin E supplements soared. In 1990, almost nobody took vitamin E; by the end of the decade an estimated 23 million US citizens were knocking back daily doses. |
“Treatment with beta carotene, vitamin A, and vitamin E may increase mortality”
That is the conclusion of a recent paper in the Journal of the American Medical Association, “Mortality in Randomized Trials of Antioxidant Supplements for Primary and Secondary Prevention” Systematic Review and Meta-analysis”, [Get the full text].
This isn’t original research, but a meta analysis that attempts to collate existing data taking into account the reliability of each source. The aim was to analyze the effects of antioxidant supplements (beta carotene, vitamins A and E, vitamin C [ascorbic acid], and selenium) on deaths (from any cause) in adults. The analysis seems to have been done well, and the results are startling. They aren’t just a waste of money, but some of them are actually bad for you. In 47 low-bias trials with 180 938 participants, beta carotene increased death rates by 7 per cent, vitamin A by 16 per cent, and vitamin E by 4 per cent (when taken separately). Vitamin C gave contradictory results and selenium showed no detectable effect.
This work got an excellent write-up in The Times, by their health correspondent, Nigel Hawkes. This was followed by a predictably silly defence of nutribollocks by the Times’ Dr Thomas Stuttaford (known in Private Eye as Dr Utterfraud). Luckily, this was neutralised by a second piece on the same page by Nigel Hawkes, “Phooey. Sensible balanced diet is the best investment”:
“ In nutrition, a plausible idea and a little bit of evidence are all that is needed to create a market. And such is the megaphone of marketing and the influence of countless “healthy eating” articles that these ideas, even the half-baked ones, can lodge very firmly in the national psyche.”
It’s a nice coincidence that this study came out while I was reading Dan Hurley’s book, Natural Causes (see below). This book sets out dramatically the harm, sometimes serious harm, that untested “supplements” have done to some individuals. But for me the most interesting part is the revelation of the political lobbying by this $20 billion supplement industry, with the aim (largely successful) of undermining the FDA and escaping from any effective regulation of its absurd, but exceedingly profitable, claims. The supplements industry puts the Prince of Wales in the shade when it comes to subverting common sense and good science.
The Health Supplements Information Service (HSIS)
Needless to say, the supplements industry has already organised vilification of this excellent bit of work.
According to their web site,
“HSIS is funded by The Boots Company PLC, Bayer PLC, Perrigo, Seven Seas Ltd and Wyeth Consumer Healthcare. The campaign is co-ordinated by PAGB (Proprietary Association of Great Britain)”.
So it’s no surprise that their spokesperson. Dr Ann Walker, immediately tried to discredit the study, saying “The results of these mixed-sample metaanalyses are worthless” (The Times).
This same Ann Walker recently wrote and editorial in the British Journal of General Practice (January 2007). The editorial concludes “Although still considered to be controversial by some, taking a daily multinutrient supplement would bridge the gap between intake and requirements and ensure that nutrient target intakes are met.” But in this editorial her affiliation is given as Senior Lecturer in Human Nutrition, University of Reading. No mention at all of her role as spokesperson for the Supplements industry. Tut tut.
Patrick Holford too
Needless to say, supplement salesman Patrick Holford has weighed into the vilification. His objections have been dealt with nicely on the cutely named web site stopholfordtalkingrubbish.blogspot.com. Find the answers here.
Holford is the man who, in the BMJ said “Competing interests: none declared”, when promoting his supplements.
No interests? Holford himself has said
“any product, be it a publication, seminar, food or supplement, that is authored/invented by me has my name on it and earns me a royalty/payment. That is how I live and fund my research.”
So what about the galaxy of supplements being sold at “Health products for Life”? They say “we only supply supplements, foods and drinks that are recommended by nutrition expert, Patrick Holford.” And at the bottom of the page it says “©Copyright 2007 Holford and Associates. All Rights Reserved”. Companies House lists the sole shareholder in ‘Health Products for Life’ as P.J. Holford.
Garlic is no good either
Another interesting recent paper has appeared in Archives of Internal Medicine
Garlic is widely promoted as a cholesterol-lowering agent, but the evidence so far has been lousy. In this trial, 192 adults with low-density lipoprotein cholesterol (LDL-C) concentrations of 130 to 190 mg/dL (3.36-4.91 mmol/L) were randomly assigned to one of the following four treatment arms: raw garlic, powdered garlic supplement, aged garlic extract supplement, or placebo.
“Conclusions None of the forms of garlic used in this study, including raw garlic, when given at an approximate dose of a 4-g clove per day, 6 d/wk for 6 months, had statistically or clinically significant effects on LDL-C or other plasma lipid concentrations in adults with moderate hypercholesterolemia.”
Using potassium dichromate to treat patients in intensive care (rather than to clean the glassware)?
No, that isn’t a joke. The respectable journal, Chest, official journal of the American College of Chest Physicians, published an article that purported to show that homeopathic potassium dichromate (i.e. water) was a useful way to treat patients in intensive care. [Frass M, Dielacher C, Linkesch M, et al. Influence of potassium dichromate on tracheal secretions in critically ill patients. Chest 2005; 27:936–941].
The title and abstract don’t mention the word ‘homeopathy’ at all. Potassium dichromate, like all hexavalent chromium compounds, is very toxic, but luckily for the patients there was no potassium dichromate present whatsoever in the treatment (it was a 30C dilution). The editor of Chest didn’t seem to think that there was anything very odd about this, but he did publish a response from me: Treating Critically Ill Patients With Sugar Pills, Chest, 131 , 645, 2007 [Get pdf ].
“It is one thing to tolerate homeopathy as a harmless 19th century eccentricity for its placebo effect in minor self-limiting conditions like colds. It is quite another to have it recommended for seriously ill patients. That is downright dangerous.”
This was accompanied by an unrepentant response from Frass.
The Frass paper has now received some close attention on the Respectful Insolence blog. Someone posting under the name ‘getzal’ has done a nice analysis which shows that the control group must have contained patients who were were more seriously ill than the homeopathically-treated group.