Archive for July, 2008

Black is white.. day is night.. less is more.. nothing is everything (yes, homoeopathy again)

July 15, 2008

One of the more reliable sources of online laughs recently has been the comments thread following a ludicrous letter criticizing the rather wonderful Professor Edzard Ernst that appeared in the Times Higher Educational Supplement a couple of weeks back.

The letter was penned by Michelle Shine, a London homeopath. Shine is criticizing Ernst for applying critical appraisal to CAM therapies (well, she would, wouldn’t she?).

Apparently, in Michelle’s view, this is not what a Professor of Complementary Medicine should be doing. He should be “giving leadership”…

Hmm. You might think this is precisely what Ernst is doing. He is leading by example, demonstrating to the “CAM community” that, if they really want to be integrated with the mainstream of medicine, they have to adhere to the same standards of evidence we demand for other treatments.

Sounds like leadership to me.

It also sounds like what academics are supposed to do – serious investigation, critical analysis, and trying to get to the root of what works, and what doesn’t – and how what does work, works.

But apparently that isn’t leadership (according to Michelle). Or what a Professor of Complementary Medicine is supposed to do (according to Michelle).

Professor and PR – they both begin the same way? Errm?

From the tone of her letter, Michelle Shine thinks Ernst’s job is not to study CAM. Rather, his job is to promote it. We can infer, I think, that this means uncritically promote it, which is what homeopaths like Michelle do for homeopathy. As many different Bad Science bloggers have recounted, the non-medical homeopaths mostly think that homeopathy is an “entire self-consistent healing philosophy”, and can treat anything, from asthma to major depression to cancer to HIV/AIDS. Oh, and it can prevent malaria as well [not] [1].

Rather more shamefully, Michelle Shine implies that by studying CAM, rather than promoting it, Ernst is “betraying” the ideals of the person who funded the Exeter Complementary Medicine Chair – the late building magnate Sir (John) Maurice Laing (1918-2008).

Shine writes:

“Sir Maurice Laing originally funded the chair that bears his name at the Peninsula Medical School in Exeter because he was passionate about CAM. His wife, Hilda, had suffered for years from tuberculosis and was cured of this serious disease through the use of a CAM discipline, very possibly homoeopathy.

There is a significant body of high-quality scientific research supporting homoeopathy, which can now be added to more than 200 years of case histories – all of which verifies homoeopathy as a valid system of medicine.

Consequently, Ernst’s “interventions” on behalf of homoeopathy/CAMs must be causing Sir Maurice to turn in his grave.”

Why the THES printed this snide personal attack at all escapes me.

Apart from anything else, it is not true. Even the bit that implies Laing must have wished he had hired a PR man.

A quick google through the THES archive reveals an obituary for Laing, published earlier this year. The piece includes quotes from Edzard Ernst’s reminiscences at a Memorial Service for Laing.

“Interestingly, while much of the research carried out by Professor Ernst was at odds with Sir Maurice’s strongly held belief in the value of alternative medicine, [Sir Maurice] never pulled the plug on the post, instead stumping up yet more money when it was needed.

After ten years, the £1 million endowment ran out and Professor Ernst turned to him for more funding after promises of money from other sources fell through. Sir Maurice sent a cheque in the post for another £500,000, made out in his name.

“It took him no time at all to comprehend and respect that I had no plans to promote anything and was devoted to scientifically testing these treatments,” Professor Ernst said. “He began to hear from numerous sources that I was not sufficiently supportive of the field, but he kept encouraging me to do the rigorous science.”

Which suggests that Laing, unlike Michelle Shine and her homeopathic friends, understood that University Professors are supposed to be serious scholars, and also that establishing something as a viable treatment in medicine requires evidence that it works.

Last week Edzard Ernst responded directly in the THES to Shine’s jibes. His response is worth reproducing in full.

“In our book Trick or Treatment? Alternative Medicine on Trial, Simon Singh and I evaluate the evidence for or against some 40 alternative therapies. We stress that several are backed by encouraging evidence while others are not.

In the case of homoeopathy, we conclude that “there is a mountain of evidence to suggest that homoeopathic remedies simply do not work”, which should not be surprising because they “typically do not contain a single molecule of any active ingredients”.

Homoeopaths have reacted by stating that:

  • we misrepresent data
  • we are bought by big pharma
  • I was fired by the General Medical Council
  • I am a bad scientist, a fraud and a quack.

Now Michelle Shine has added to this long list of insults and lies by claiming that I am “falling short of (my) job remit” and that I cause Sir Maurice Laing (who endowed my chair) “to turn in his grave” (Letters, 3 July).

During many meetings, Sir Maurice encouraged me to conduct the most rigorous research possible, regardless of what it might find. Shine points out that my remit is to “speak for complementary medicine to government, the public and within the university”. But this is precisely what I have done during the past 15 years, publishing about 1,000 articles in medical journals. However, to speak “for” a subject does not mean telling untruths. We all seem to have got used to homoeopaths misleading the public, but British scientists and academics are bound to insist on the best evidence available to date.”

So Ernst is a man of integrity, as was Sir Maurice Laing.

Unlike, one is forced to conclude, many homeopaths.

In the meantime, the comments thread below Shine’s letter has featured, over this last fortnight, a selection of bad science people (supporting Ernst, and pointing out the falsehoods in Shine’s letter) and of homeopaths giving Shine their vocal support.

One homeopath who showed up is William Alderson:

William trained at The London School of Classical Homoeopathy. He had originally sought homeopathic treatment out of desperation, but it was not simply the success of the treatment that convinced him of the importance of homeopathy. When he read Samuel Hahnemann’s Organon of Medicine and discovered that this was a medical system with a sound scientific basis, he determined to find out more, and ultimately to train as a homeopath himself. (emphasis mine)

Goodness. As William Alderson’s bio reveals, he is a man of many and varied talents. Unfortunately, the ability to tell whether something has a “sound scientific basis” is clearly not among them.

I especially had to laugh when I read Alderson’s comment that:

“The effects of [homeopathic] potentised remedies are highly implausible only if you limit your scientific approach to that of chemistry, and if you rigorously use an inappropriate test. If a wider range of scientific investigatory techniques are used, and if appropriate tests are used, then the results have the chance of according with the clinical evidence – 200 years of clinical evidence.”

Ho hum. And day is night, and black is white. At least in William Alderson’s homeopathic parallel universe (homeoverse?).

A brief recap. It has been repeated ad nauseam that, for homeopathic remedies to have biological actions, one would have to explain how “no molecules” can do more than “some molecules”. “Potentised” means, or course, “diluted with shaking, which shaking is believed by homeopaths to impart magical healing properties”. Following the dilution, there are no molecules of “remedy substances” left. None.

For this potion to do something, one would also have to explain how water magically “remembers” having once had something dissolved in it, when that stuff is not there any more. Water molecules “jostle” one another on a molecular scale at such a speed that any “space” left by a substance that was once there would be gone in a matter of a picosecond (a millionth of a millionth of a second) at the very most, and probably much quicker.

In addition, absolutely no credible science exists to show that a homeopathic remedy is distinguishable from pure water. James Randi famously offered a million dollars to anyone who could credibly demonstrate a “paranormal phenomenon” (homeopathy would qualify, see the noted Horizon programme a few years back), while Edzard Ernst and Simon Singh have recently offered ten thousands pounds of their own money to anyone who can show by any scientific method that homeopathic remedies are distinguishable from water.

No claimants have shown up to claim Ernst and Singh’s prize, and Randi still has his million bucks.

Finally, the homeopathic canard about “sceptics don’t use proper tests” (put another way: “Double blind trials to test our healing power? No fair!”) has been magisterially debunked by Ben Goldacre in his definitive pwning of homeopathy, and in many other places too.

So everything – everything – in Alderson’s ringing statement is…. well, frankly, rubbish.

As an academic used to correcting students’ misconceptions, I thought I ought to re-phrase Alderson’s statement to make its breath-taking ludicrousness a bit clearer. Or better still, I will correct it along the lines of a student project report or thesis, to make it clear what Alderson is really saying:

Key:

Bold black for Alderson’s original words

Blue for the new edits to clarify the meaning

Red for deletions

“The effects of potentised remedies are highly implausible only if you limit your scientific approach to that of using all the known laws of physics, chemistry and biology, and if you rigorously use an inappropriate test the same established tests proven over decades of experience to be the best way to test medical treatments.

If a wider range of scientific and pseudo-scientific investigatory techniques are used, including techniques that are inadequately controlled and or/spurious, and if inappropriate tests are used that do not rigorously exclude experimenter, observer and reporter biases, then the results have the chance of coming out apparently positive – according with the subset of the available “clinical evidence” that we homeopaths like to bang on about, namely 200 years of anecdotes, famously the least reliable kind of medical evidence there is. We will ignore the more rigorous clinical evidence that does not suit our a priori belief-based position, namely all the blinded trials and meta-analyses that demonstrate that homeopathy is simply an elaborate placebo.”.

Incidentally, it is not terribly surprising that William Alderson has appeared to fight Shine’s corner, as they seem to be close associates. Both are, or have been, associated with a recently set up charity HMC21, or “Homeopathy: Medicine for the 21st century”. Michelle Shine, according to this homeopathy website, was formerly Chair of the group, while William Alderson is the secretary.

HMC21 says its purpose is to:

“promote homeopathy, and to defend the right of people in the UK to choose homeopathy as a therapy within the National Health Service”

Obviously the way to do that is for people like Michelle to accuse Edzard Ernst of being dishonest, and for Alderson to back her up with 42-carat nonsense.

Let’s hope their squeakings are treated with the derision they deserve.

Are you listening, Vice Chancellors?

And… is it too much to hope that the Vice Chancellors of those Universities offering “B.Sc. degrees” in Homeopathy and other belief-based nonsense might be reading these exchanges in their THES? And getting a reminder of the difference between scholarship and education on the one hand, and promotion and pseudoscience on the other?

Thought for the day

Finally, before I sign off, I thought I would try my hand at writing an advertising blurb for HMC21, and for the many homeopaths who seems to be able to achieve a stunning level of unconscious quantum doublethink when it comes to their preferred brand of belief-based wibble.

“Don’t like the physical laws of this universe? Insist on being judged by the laws of a parallel one you thought up specially!

Choose Homeopathy now!”

Just don’t expect me not to complain if you are trying to spend my taxes on promoting your parallel reality.

———————————————————————

1. Over at his Thinking Is Dangerous blog, Dr* T recently celebrated the 2nd anniversary of the Simon Singh / Sense About Science BBC Newsnight investigation of homeopathic practitioners and pharmacies who recommended homeopathic malarial prophylaxis to people proposing to visit malaria-endemic countries. The anniversary has now triggered a series of other badscience bloggers to post comments about the British Royal Family’s favourite quackery. Enjoy.

Marin-ated in Woo

July 5, 2008

One of the abiding questions in the bad science fraternity is:

“Where on earth did all this Wibble come from?”

(“Wibble” being Dr John Crippen’s slightly more whimsical synonym for “Woo”)

There are all sorts of answers to this question.

One, of course, is that Woo/Wibble has always been with us. After all, Samuel_Hahnemann’s homeopathy is two hundred years old – as the homeopaths love to remind us, as if the persistence of an Alt.Reality belief system conferred any special legitimacy on it. And “Ancient Folk Wisdom” is, well, ancient – although it is necessary to note that much of what is nowadays being sold as “ancient folk healing wisdom” is nothing of the kind [1].

No. When Bad Science people ask “where does all the Woo / Wibble come from?”, they are usually asking two things.

Firstly, why is it so mystifyingly popular, given the advances science has made in understanding the natural world since the Enlightenment, and the progress that medicine has made in understanding and treating disease, especially over the last 50-60 years?

Secondly, who started this bizarre obsession with things like nutrition woo, ”Vitamania” and “Detox”?

A third question is where and when these ideas came to be so linked with the notion that embracing Woo is “empowering”, and is a statement of one’s freedom from corporate consumerism – something that is manifestly untrue, since Woo is a multi-billion dollar business, and is increasingly of interest to large companies.

I would like to suggest a possible answer to at least one or two of the above questions.

In answer to the question “Where on earth does it all come from”, I think I may have pinpointed the place – and as in so many things, it is all the fault of California.

Step forward, Marin County.

Or rather, lets step back to Marin County in the mid 1970s.

Because mid-70s, affluent, San Francisco Bay-area California seems to have been a key Woo-incubator.

If you’re going to San Francisco, be sure and wear some (Bach)_flowers in your hair

The best place to learn about the mid-70s Marin lifestyle is in one of the funniest satirical novels ever written about Californian (and, increasingly, global First World) obsessions, Cyra_McFadden’s brilliant The_Serial (subtitled “A year in the Life of Marin County”).

McFadden’s book is fondly remembered by those of us old enough to have read it in the 80s, or even the 70s. Last year, in a Guardian story about American health food chain Whole Foods Market opening up a Kensington outlet, Stephen_Bayley pithily described it thus:

“The best account of the hippy culture that gave rise to Whole Foods is Cyra McFadden’s superb 1977 cartoon novel, The Serial. Here she established an affinity between 12-speed bikes, high net worth, yoga, eternal life and the consumption of mung beans.”

And that gets close to the root of it. A lot of the first world craze for Alt Medicine has, in my view, to do with the angst that goes with being prosperous, relatively free of lethal threats to one’s life (whether disease epidemics or shooting wars), and yet still sneakingly aware that one is not immortal.

[Though to deal with this by obsessing about Alternative Reality in general, and CAM and nutritionism in particular, still seems strange to me. It always puts me in mind of the old joke: “Eating a vegan diet won’t make you live forever. It’ll just feel that way”]

The Serial was, as the name suggests, originally serialised in a local Marin County alternative newspaper in 1976-7. It is now sadly out of print [2]. This is a pity, since it skewers the pretensions and idiocies of worried wealthy middle-class navel-gazers like no other book I know, and would make salutary reading for anyone prone to embracing Alt.Reality as a result of their Affluenza..

The Wikipedia description of the book is a good introduction to it, but in case you can’t be bothered to click it:

Meet the Holroyds

The central characters of The Serial are Kate and Harvey Holroyd, a moderately prosperous and aspirational couple in their late 30s or therebouts who are having marital troubles. In the course of the book Kate and Harvey “explore their options”, both lifestyle- and relationship-wise, before ending up back together (just about).

On re-reading The Serial recently, and for the first time in around a decade, I was struck by the amount of stuff in it that would be instantly recognisable to regular readers of Holfordwatch, or indeed to anyone who peruses the “Lifestyle” sections of our national newspapers, or (for those of non-delicate disposition) Patrick Holford’s or Dr John Briffa’s websites.

Anyway, let’s get a taste of what the Marin-istas of the mid-70s were about.

Marlene and Harvey

The book’s single most nutrition-conscious character is Marlene, the ex-cheerleader that Harvey shacks up with during his “Sabbatical” from his marriage. Harvey meets Marlene at the check-out till in Safeway when she expresses horror at “the garbage” he eats:

“Do you know what white flour does to you?” she asked him… “It kills your enzymes”… (Ch 8).

Marlene soon moves in to Harvey’s bachelor pad, putting him on a punishing regime of (tantric?) sex, kelp and soya_milk, and sending him out in search of “organic fibre”. However, Harvey eventually begins to chafe at the new menu and the attendant beliefs:

“…Marlene was a raving fanatic about nutrition; she lectured Harvey endlessly about things like the body’s need for zinc, and wasn’t amused when he suggested amiably that they go out and chew on the Volvo bumper” (Ch 10)

Subsequently things turn a bit nasty when Marlene catches Harvey surreptitiously scoffing barbecue-flavour Fritos in the bathroom with the water running:

“First she screamed at him that if he was going to poison himself on chemical preservatives she “couldn’t be responsible”. Then she made him drink a quart of kefir to “neutralize the toxins”” (Ch 10).

Many other quintessential Altie enthusiasms also appear in the book: for instance, Vitamin E supplements (Ch 14); avoiding emulsifiers (Ch 20); ”bacon’s full of carcinogens” (Ch 24); lecithin deficiency (Ch 47). And there are more.

“Mind-body therapies” also feature; almost every character is “in therapy”, or, to put it in Marin-speak, “heavily into personal growth”. One character hands out gift certificates from the Physical Therapy Centre, which read:

“A new path to health has been opened to you…. May you continue to grow in balanced harmony…. Please Call to learn about your new options in life (Ch 51)

Children are not exempt

The 70s Marin gestalt also extends to children and child-raising. In the following excerpt ten year-old Che, son of one of Kate’s friends, has been sent away to holistic summer camp:

“When [Che]… broke out into a rash, envisioning himself brought to a rolling boil in the hot tub, his Surrogate Parent for the session made him drink a lot of lemon-grass tea. “Listen, Che,” said [his surrogate parent], “you’ve just made a conscious decision. You’re the one that decides to get sick or stay healthy. Listen, you want your body to call the shots?”

Che just wanted the camp to call [his mother] and tell her he’d forgotten his cortisone ointment. Maybe she’d come and bring it to him and he could hide out in the trunk of the Rover. Otherwise he was in for two more weeks of unstructured freedom that stopped short of “pharmaceuticals”…

Glumly, he consulted the bulletin board, listing the afternoon’s activities, posted outside the communal yurt:: belly dancing, spear fishing and herbal medicine. Che didn’t know what herbal medicine was but suspected lemon-grass tea was part of it.” (Ch 43)

Now it is impossible, I think, to not be struck by the correspondence between all this and the nonsense peddled daily in the “Health and Lifestyle” pages of newspapers, in the books of Holford et al., and on innumerable natural health websites. Lots of people are vaguely worried. And you can bet someone is going to sell them “the solution” to their worries, even if that solution is a bunch of bullshit.

Angst + Woo = ker-chinnng!

This is aptly summed up by an excerpt from one of The Serial’s earliest chapters (Ch 4), when Kate’s psychologist friend Leonard tries to persuade her to work on “getting clear” by attending a weekend at his retreat. Leonard lists services offered:

…he began to chant seductively. “Wholistic nutrition…hypnosis…biofeedback… massage”. Kate was beginning to hyperventilate when he added, in another voice entirely, “Friday night through Sunday noon. One hundred and fifty bucks if you crash in the dorm. Extra charge for the hot tub. I take Master Charge, Amex, all your major credit cards.”

Which shows that the basic schtick of Alternative Therapy has not changed all that much in the intervening thirty plus years.

It’s just that now you don’t have to take a trip to the West Coast. You and your bank balance can get taken for a (wholistic) ride in Hemel Hempstead. Or central London. Or even rural Yorkshire.

Now there’s progress for you. Just don’t forget to bring an open mind [3]. And a major credit card.

—————————————————————————–

[1] The Quackometer has a brilliant summary of the modern origins of many varieties of purportedly “ancient wisdom” Woo here.

[2] Although various editions can still be found second-hand – see for instance here and here.

[3] “Keep an open mind, but not so open that your brain falls out” – usually attributed to Richard_Feynman.


Follow

Get every new post delivered to your Inbox.

Join 1,991 other followers