Archive for August, 2008

Back crack quack attack – it’s a legal matter, baby

August 21, 2008

Dr Aust finally (late as ever) tries to think of something new to say about the back-crackers vs. Simon Singh, and about British libel laws and Alt.Reality in general.

The Bad Science Blogosphere has been full, these last couple of weeks, of the Back-crackers – sorry, I should say “the chiropractors” – rushing to M’Learned Friends when people say mean things about them. (NB – for non-UK readers, “M’Learned Friends” is a British term for lawyers – usually highly-paid ones).

The first example was the New Zealand Chiropractors Association threatening to sue the New Zealand Medical Journal – who have comprehensively called their bluff by publishing the letter from the Back-crackers’ legal mouthpiece, together with an unrepentant re-statement of their main points of issue with the Back-crackers (see David Colquhoun’s blog for details and for links to the articles). More recently, in the UK, the British Chiropractic Association or BCA (who are one of several chiropractors’ professional associations in the UK, and say they represent “over 50%” of UK chiropractors) has issued legal proceedings for defamation against noted science writer Simon Singh for an article he wrote in the Guardian under the paper’s Comment is Free banner.

Singh’s comments, which can be read in Blogospace here and here, were clearly derived from Trick or treatment?, the book about Alternative Medicine he recently published together with Professor Edzard Ernst. Given all the research that went into the book, and Ernst’s many papers on the subject, Singh should be well equipped with any information he needs to argue for the accuracy of his statements in a courtroom. Gimpy’s excellent post sets out, point by point, some of the scientific references that back up what Singh wrote.

Unfortunately, in UK defamation law, the defence of “justification” – the statements complained of as defamatory were in fact true – has a reputation as rather a risky option. In contrast to most other countries, the burden of proving the truth of what was said rests wholly on the libel defendant. Furthermore, there is no general defence of “public interest”. A rather qualified “public interest” defence has recently become possible in UK libel courts – though constructed by judicial ruling and predecent, and not by legislation – the so-called ”Reynolds_Defence”. However, the press (and “citizen journalists” and internet commentators) enjoy nothing like the protection they have in the US under the Freedom of speech laws and the New York Times v. Sullivan decision.

UK Libel Law – protecting the rich and the con-men?

The Singh lawsuit thus arrives at a time when UK libel law is increasingly something of a pariah. The UK’s anomalously plaintiff-friendly law has been criticized both at home and abroad for producing the depressing phenomenon of “libel tourism”, and was recently characterized by a UN report as. “serv[ing] to discourage critical media reporting on matters of serious public interest”.

Libel tourism arises when someone invents rather thin grounds for sueing in the complainant-friendly UK courts, rather than in the jurisdiction where most people would view any offence as having actually being committed The phenomenon goes back several decades, as discussed here. Two high-profile recent cases (widely discussed in the press e.g. here) have involved books written by American authors, and published in the US, but purchased by a mere handful of UK-based readers (precisely twenty-three in one case) via the Internet. The plaintiffs did not bother suing in the US, where they would have had no chance of a judgment in their favour. Instead , they sued in the UK for the “damage to their reputation”, making the argument that the ability of UK residents to order the book, and the availability of part of the book online, proved that case could reasonably be heard in the UK. This has since led to the passing of legislation in New York State to make it legally impossible to attempt to enforce in their jurisdiction a judgment made by the overseas (UK) court in libel cases. The New York legislators clearly saw the libel tourism as an attempt to make an “end-run” around US constitutionally-guaranteed freedom of speech. Subsequently, bills essentially to replicate the New York guarantee of “no imported libel chill” have been tabled in the US House of Representatives and Senate.

Whether one views the fuss over the recent cases as being wholly concerned with free speech – and the two cases which have made this a “hot button” issue for the US legislators do relate specifically to allegations concerning terrorism – it is clearly of some concern to UK citizens when other democracies start passing laws to strike down our laws as repressive. Many UK press commentators have made this point, including Geoffrey Wheatcroft:

“For years journalists have grumbled about the [English] libel laws and no one has listened, but when a distant legislature passes a law of its own to counteract the intolerable effects of the British courts then it’s time to take notice. The most startling recent legal story comes not from the high court but from Albany, where the New York state legislature has introduced the starkly named Libel Terrorism Prevention Act, intended specifically to guard writers and publishers outside British jurisdiction from the terrors of English libel law.”

Of course, the use of UK libel law by our own rich and powerful to suppress adverse comment is already well known to UK readers – one need only name Jeffrey Archer, Jonathan Aitken, and perhaps most egregiously of all the late Robert Maxwell, famous (infamous?) in life for his frequent recourse to M’Learned Friends.

In the context of English libel law reform, the UN’s comments last week, already noted above, were particularly interesting since the information they had studied had apparently been provided to them by the UK Government, or at least by its civil servants. This might lead one to hope that the issue of libel law reform is under discussion in high places in the UK, though as yet there seems no sniff of new legislation. More on this, and on libel tourism and UK free speech in general, in two recent Guardian articles by Tim Luckhurst and Duncan Campbell

Bad medicine, Alt.Reality and the public interest

Anyway, after that long and probably multiply inaccurate digression, back to Simon Singh and the back-crackers. Singh’s comments about the Chiropractors could serve as an obvious example of “critical media reporting on matters of serious public interest”. Although his easiest defence to the libel action might actually be to argue that the column was to be read as an “Opinion” rather than “authoritative reporting”, as I will explain later.

Unfortunately for us ordinary citizens (bloggers included), law is a minefield of obscure meanings and verbal convolutions, and UK libel law is no exception. However, ”Jack of Kent”, a blogger who is both a skeptic and a media and communications lawyer, has done some nice de-convoluting for us over on his blog. From his On Simon Singh and the chiropractors:

“First, the BCA is able to sue because it is a “legal person”, that is, a company. If it were a public authority, like the statutory General Chiropractic Council [who license all UK chiropractors – Dr Aust] it would not be able to sue under the “Derbyshire Rule” preventing such bodies from suing for defamation. It would be good if the High Court used this case to extend the Derbyshire Rule to such representative bodies: a nice gunshot wound to the BCA’s own foot…”

And in a post specifically on English Libel Law – A Brief Guide for the Perplexed, he explains the process that occurs in a libel action:

”1. The “claimant” (in this case the BCA) will first need to show that they have been defamed. This is a common law test and it usually means that the claimant’s reputation has suffered. A defamatory statement in permanent form is called a “libel” (in transient form, it is a “slander”).”

On this first point alone, it would seem the chiropractors would have little difficulty in demonstrating that Singh’s remarks would tend to make an average person think worse of chiropractic than they did before they read the article. That was pretty much the point.

However, it is not quite that simple: J of K goes on to make a crucial distinction that I had not properly appreciated:


”The claim form [detailing the alleged libelous contents] issued by the BCA has not been published, but one must presume that they are complaining that a direct (or implied) statement about the BCA by Simon Singh has the effect of lowering their reputation (rather than say the reputation of Chiropractic generally).”

This is quite interesting. The BCA can sue Singh because they are a professional association and thus a company / charity, which gives them a right to protect their reputation. However, most of Singh’s article (links above), refers to chiropractic in general, and not to the BCA in particular. The offending remarks they are complaining of must therefore be wholly, or at least primarily, the two sentences in Singh’s article (in the third paragraph) that refer directly to the BCA:

“The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organization is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

(italics mine).

The indefatigable Gimpy has traced the probable source of these statement to a document on the BCA’s website. This document is entitled

”Happy families”

and subtitled:

Chiropractic – the natural health choice for the whole family

This document contains the following section (yellow highlighting for the notable bit):

Birth trauma

Although a natural process, birth is sometimes traumatic for both mother and baby, Chiropractic may help you and your baby recover from any birth trauma. Treatment aims to relieve the stress that can affect your baby’s neck and head, especially if forceps or other medical assistance was involved, or if it was a breech birth.

There is evidence to show that chiropractic care has helped children with the following symptoms:

Asthma …Colic

Prolonged crying …Sleep and feeding problems

Breathing difficulties … Hyperactivity

Bedwetting …Frequent infections, especially in the ears”

The list of conditions is identical to those in Singh’s disappeared article. It would thus seem that the only thing in Singh’s article that can be construed as directly defamatory to the BCA are the two sentences / phrases which imply that the BCA are promoting treatments for which there is no scientific evidence (see above).

The law at work

Jack of Kent also explains, in his post summarizing the workings of English libel law, what happens once the plaintiff has set out precisely how they feel they have been libeled:

“2. Once the claimant has established that the statement is defamatory, the onus [for proving the statement were not libelous] then shifts to the “defendant” (here, Simon Singh). This “reverse burden” of proof means that English libel law is regarded as unfair to defendants and too advantageous to the claimant.

3. There are three common defences: privilege, fair comment, justification. The defence adopted will depend mainly on what the claimant says is the defamatory meaning of the alleged libel.”

Now, as I understand it (based on my new Jenny McCarthy-style ”University of Google” two-hour-degree in British defamation law), all three of these defences would be feasible in an action of this type.

Justification – the statements are true

“Justification” at first sight seems the obvious one, but this is slightly two-edged in the context of British libel law since one might conceivably have to justify the exact choice of wording, and debate its possible meanings..

To explain this, consider the following hypothetical scenario.

Let’s say that a charity called the “Breath Foundation” promotes special breathing exercises as a cure-all for all sorts of childhood ailments. Let’s say I have written an article in which I say that the Foundation and its therapist members promote these therapies “even though there is not a jot of evidence” that they work. And let’s say that they have then sued me for defamation.

Next, let’s imagine that there are ten studies published in the medical literature assessing breathing exercises for one of these conditions in particular, say childhood asthma. Let’s imagine that nine studies, find that the therapy is useless. The tenth study is rather equivocal, and technically of poor quality, but finds some weak evidence of benefit.

The question is, can I summarize this as there being “not a jot of evidence” [that breathing exercises help childhood asthma]? I could, have written something less blunt: for, instance, instead of “even though there is not a jot of evidence.”, I could have put “even though the scientific evidence overwhelmingly contradicts this claim”. Do these phrases carry the same meaning? Using a “justification” defence when the Breath Foundation sues me effectively argues that they do. The argument could certainly be made – nine studies to one would probably equate in a systematic review or meta-analysis to “essentially no evidence”, but it could perhaps be argued the other way by a plaintiff’s libel lawyer. If we analogize this to Simon Singh and the BCA, the BCA’s lawyer might be going to argue that Singh overstated the evidence to make his words carry the implication that the BCA were lying.

One can also concoct slightly different versions of this argument, and one in particular is interesting as it carries a wider implication for CAM therapies and their advocates, and the way they promote and justify what they do.

In this modified scenario, suppose that the scientific and medical literature all points one way – to the therapies being without effect – but the CAM professional association’s members’ testimonials – “what my patients have told me” – are all positive (as it is quite possible they would be – the satisfied customers write the nice letters, while the dissatisfied ones commonly don’t come back).

The CAM professional association might then argue, including through their lawyers, that this constitutes the “evidence” on which they, in good faith, base their claims about their therapy. As I understand the law – and I’m hoping Jack of Kent, or some other legal eagle, will be by to correct me if I have it wrong – it then falls to the debunker – e.g. Singh and his lawyers in the BCA vs. Singh suit – to convince the court that this does not constitute “evidence” in a way that a normal reader reading the BCA’s website, or Singh’s article, would understand it. Again, possible, but not altogether straightforward.

Finally, in the light of the above arguments, consider in my hypothetical example what would happen if I had also written that the Breath Foundation “happily promotes bogus treatments”. Again, how easy is it to demonstrate that this precise wording is true, as a judge would understand it? Could my hypothetical Breath Foundation argue that the treatment is not “bogus” if they sincerely believe in it, even if the scientific and medical consensus is wholly against it? This question, in turn, might hinge on whether the Breath Foundation’s own documents imply that the treatments are backed by scientific evidence.

As I have already noted, what, exactly, do we take the statement “There is evidence” in any Alternative Therapy organizations promotional or information leaflet to imply? What kind of evidence? Scientific? One positive study? A broad consensus? A meta-analysis? Patient testimonials?

[In fact, one possible outcome of a case like the BCA vs. Simon Singh is that we will get a precedent in this regard. Personally, I would have said that, if the claim is made for a ”medical therapy”, then the word “evidence” should be taken to mean “evidence of the type and standard routinely applied to conventional medical therapies”]

Now, while lawyers and especially judges are very smart people, and well-equipped to see through a load of flim-flam or a “legal filibuster” (see e.g. Mr Justice Eady’s interim ruling in Andrew “MMR” Wakefield’s ultimately abandoned delaying libel action against journalist Brian Deer), it is easy to see how an argument of this kind could be a long and involved argument. And also how, in certain cases, it might give quacks a way to defend their purported “reputation” without having to engage too closely with the real scientific truth.

Fair Comment

Given all the above arguments, a “fair comment” defence is likely to be Singh’s safest bet in law. As one legal website puts it:

“The defence of “fair comment” may be available to a defendant who can show that the defamatory statement amounted to an opinion which was honestly held and based on facts which were true.”

Here, what Singh has written could clearly be regarded as his (and Edzard Ernst’s) honestly held opinion, based on (i) the claims made in the BCA document, and (ii) Singh’s and Ernst’s knowledge of the actual published medical evidence that relates to these particular claims. This “opinion based on the facts, which are these”, would seem to me to be the clearest and most straightforward defence. – though (disclaimer) I am not a lawyer.

Of course, it could be argued that defending the action this way does not have quite the “moral force” of defending it based on saying “every statement I made was demonstrably true”. But it could be rather less work.

Qualified privilege

The final defence would be one of “qualified privilege”. The specific kind of qualified privilege can be described as follows (taken from www.website-law.co.uk):

“The third (and most interesting) kind [of qualified privilege defence] is sometimes called “Reynolds-style qualified privilege”. This protects certain public interest stories published in the media, providing they adhere to the standards of responsible journalism”

Now, the public interest in the BCA vs. Singh lawsuit is absolutely clear. As Jack of Kent pithily puts it:

“The extent of the efficacy of Chiropractic is an important area for a public debate about public health. And such a debate should not be subject to the veto of vested commercial interests.”

However, the slight snag is what “responsible journalism” is taken to mean in the Reynolds context. As I read it (and again, corrections from those better-informed are welcome), it usually covers a series of standard checklist things, including “contacting the person likely to be offended (here the BCA) before the story goes out and offering them a right of response” – think of all those articles you have read, watched or listened to that say “we tried to contact XYZ to comment on what we have said about them, but no-one was available to speak to us”.

Partly for libel lawsuit avoidance reasons, newspapers tend to badge “Comment” pieces very clearly and deliberately as “Comment” or “Opinion”. This differentiates opinion pieces (including columns) from articles on the news pages (where wording is more neutral, editorializing is curtailed, quotes are sourced to those making them, and responses are sought – think Woodward and Bernstein). This makes it less likely that the newspaper will be sued for defamation for anything published in a “Comment” article – it is being, in effect, pre-emptively labeled as “sincerely held opinion based on the facts”, with the prospect of a fair comment defence to any defamation claim. Since Singh’s piece was published under the Comment is Free banner, it is clearly labeled as “Opinion”.

Behind the scenes…?

On balance, then, I would imagine in my legally uninformed way that Singh’s simplest defence to the BCA’s claims is going to be “Fair Comment”, rather than (Reynolds) privilege or the more balls-out justification. Indeed, one would have thought “fair comment” was so obvious and sufficient a defence that there was little point in the BCA bringing the action at all.

The original news story quotes a member of the BCA governing council as saying: “It wasn’t a decision taken lightly [to sue Singh]…I know that a lot of thought went into this.”

I can’t help being curious as to what these thoughts were.

I suppose it could be that the BCA are taking the action specifically in the hope that Singh will file a “fair comment defence”, the idea being that they can then issue a ringing public statement arguing that Singh has admitted his comments about the BCA are “opinions rather than facts, by his own admission”. Of course, that would not dispute the facts on which the opinions are based.

In addition, or alternatively, it could be that the point was simply to get Singh’s article removed from the Guardian website in the meantime. In which case, the BCA have probably shot themselves in the foot spectacularly, as the ”Spartacus effect”, a.k.a. the “Streisand effect” (or even ”Obi Wan Effect”) will mean that the Singh article is likely to be intensively discussed in the Blogosphere, not to mention being rapidly republished on tens or even hundreds of online sites –think The Quackometer vs. The Society of Homeopaths, or The Quackometer and gutless webhosts Netcetera.

Defending Alt Therapies: Evidence and publications? Or law courts and M’learned Friends?

The wider point for skeptical people interested in CAM Therapies and how they are promoted is precisely what the BCA have not done.

They have not produced any kind of statement explaining why they think what Singh wrote is inaccurate.

Not in a newspaper – although I cannot believe there would not have been many happy to print a statement. Not in a press release. Not in any broadcast I have heard. And not even in the ”Latest News” Section on their own website.

Instead, they have gone straight for M’Learned Friends and the gagging effect of a Libel Writ. Precisely the same can be said of the New Zealand Chiropractors Association.

The response of the New Zealand Medical Journal’s editor, Prof Frank Frizelle, to the NZCA’s legal threats, has received wide publicity around the bad science blogosphere. As noted at the start of this article, he has challenged the NZCA, publicly, to make their argument based on published science. He has even offered them a forum.

The phrase he used, which Holfordwatch have dubbed “an instant classic” is:

“Let’s see your evidence. Not your legal muscle”.

The law is… an ass?

Lastly, back to the law. Regardless of the view we take of the BCA’s (and NZCA’s) actions as an appropriate way (or not) to respond to criticism, and whatever the easiest defence under current English law of the BCA’s idiotic action, it is hard not to feel that the defamation law as it stands is an ass.

There has been much discussion in the UK over the last few years of ways in which libel laws might be modified to place less burden on those defending defamation cases. One suggestion that has been repeatedly advanced is to modify the law so that “public figures” – under which heading one might reasonably class a large and wealthy professional association – would have to demonstrate specifically that the allegations had been made recklessly, and/or maliciously. This idea follows the US model. Another related idea is to give media comments on public interest matters special privilege.

As currently stands, it seems crystal clear that the public interest is emphatically not served by the chiropractors being able to block people from going public criticizing them To quote Jack of Kent once again:

“The article was by Britain’s leading science writer, in the comment section of a quality newspaper, discussing concerns about an important aspect of public health, that is, the treatment of sick children. If Article 10 of the European Convention on Human Rights, which protects freedom of expression, does not apply here, then we may as well not have a Human Rights Act.”

Basically, the need for some sensible new legislation is clear. Unfortunately, it seems that British Governments are historically reluctant to do anything legislative that curtails libel lawyers’ ability to trouser huge fees. Those of truly cynical mind might wonder whether this is because so many British politicians are lawyers.

Which prompts a final thought:

Perhaps this is a chance for the highly erudite and forensically intelligent ex-journalist* (with history Ph.D. from Edinburgh) who occupies No. 10 Downing Street to show us what he is made of.

After all, it seems a perfect chance; a big issue to take the focus off economic gloom; something that goes beyond petty self-interest; free speech, open debate, and a public right of fair criticism; the rich and powerful de-fanged in their attempts to control what can be said about them.

What could be more stirring than that?

Over to you, Gordon.

———————————————————————————-

*Thanks to Jack of Kent for pointing out my mistake in originally suggesting that our Prime Minister trained as a lawyer (see comments).

[BPSDB]

One alternative reality, please…! No, make that several.

August 15, 2008

In which it is re-stated that an infinite number of forms of incompatible “my personal alternative reality” nonsense can co-exist. Its, like, that multiple worlds Quantum incoherence thingy, innit?

[An apology: due to my current intermittent lack of sleep and rather fractured thinking time, I am incapable of doing anything requiring research or serious thinking – at least that’s my excuse. Miscellaneous disjointed rambling, on the other hand… …Anyway, consider yourself pre-warned]

WikiWoo… Encyclopedia Deluderanda… Quackapedia…

Several people around the Bad Science blogosphere, including both Gimpy and Martin at The Lay Scientist, have noted the recent announcement that some of the CAM gang are setting up their own Wiki. Lay Scientist reproduces parts of the announcement, with Martin’s own running commentary, while Orac gives even more detail on the “Wiki4CAM” mission statement and purpose. Gimpy has already catchily re-named the Wiki ”Quackapedia”.

One key rationale is stated to be that nasty “skeptic” editors over at the real Wikipedia keep insisting on a balanced (or fairly balanced) treatment of CAM therapies, of which Orac gives several examples.

These Wikipedia entries are about what one would expect: they outline what has been claimed; they mention the major critiques, coming from whom, and based on what. They often distinguish between the views of “advocates” or “practitioners”, and those of “scientists”. To my eye they are studiedly neutral.

In particular, Orac quotes a lengthy chunk of the Wikipedia entry on homeopathy which he – as, I am pretty sure, would David Colquhoun – finds rather mealy-mouthed, since it uses several of the neutral language distortions that the homeopaths prefer – such as “highly dilute remedies” rather than “remedies diluted well past the point where no molecule can possibly be left”. Anyway, it is hardly the clear-cut debunking of homeopathy that you can find over on a “skeptic site” like Rationalwiki.

Seemingly, though, this is not nearly enough for the CAM gang. What they want is no less than an online CAM encyclopedia that is unstintingly positive about absolutely everything to do with CAM. Hence the drive to set up a CAM-only Wiki, where all entries will be written by CAM boosters, sorry, practitioners.

Now, as I have argued elsewhere in the Bad Science blogosphere (e.g.here), no CAM therapy ever really dies out. This is partly because CAM’s lack of basis in evidence means that a CAM therapy can never be “disproven” in a way that its advocates will accept – and partly, of course, because there’s one born every minute. And given that no CAM ever dies out, we can only presume this will mean that ultimately every kind of CAM ever tried, no matter how insane, will have a glowing entry on Quackapedia written by an enthusiast.

What an enticing prospect. I can’t wait to see the currently rather disappointing entry on Urine Therapy once it’s been really beefed up with some patient testimonials and practitioner insights. Remember also that CAM believes in a sort of “spirit of benign acceptance”, so that nothing can ever be dismissed for being wholly implausible or silly… no matter how wholly implausible and silly. And if you don’t believe me, look up Radionics.

I like to shorthand this kind of post-modern dippy-ness as:

“No childish nonsense left behind”

..of course, this benign acceptance only pertains if you are sincerely deluded, or at least pretending that you are. Con-artists get the benefit of the doubt – they might be sincere – but “skeptics” (otherwise known as “almost all scientists and doctors”) must be rigorously excluded.

I am sure this makes the con artists very happy indeed.

It is tough on the skeptics, though. I sometimes muse about ”doing a Sokal” by setting up my own utterly spurious “virtual” complementary therapy website, and then asking to be included on things like Quackapedia. But I’m not sure I have the energy.

[Stop press: it appears that some people not only have the energy but are already on the job. Orac has the story here].

Million-dollar brain-twister: Who is nuttier? Quackapedia or Conservapedia?

Over at The Lay Scientist, Martin has wittily christened the set-up-your-own-wiki-so-you-can-apply-your-own-version-of-reality approach the “Schlafly Gambit”. This name honours – I use the word ironically – publicity-hungry US-Christian-right Wing-nut lawyer Andrew Schlafly. Schlafly, son of legendary anti-feminist (and committed opponent of Equal Rights laws) Phyllis Schlafly, is one of the people behind the deranged Conservapedia Wiki. This is the place where extreme right wing conservative Christian homophobes write useful, like Young Earth creationist-acceptable histories of the world - for an audience of their equally frothingly mad friends.

Andrew Schlafly has recently been making an utter spectacle of himself trying to accuse bacterial evolutionary biologist (and recently elected member of the US National Academy of Sciences) Richard Lenski of being a bad / dishonest scientist and (by implication) a tool of Godless Dark Forces. Schlafly’s posturing was thoroughly de-trousered, notably by Lenski himself, as chronicled gleefully on numerous science blogs including both Bad Science and The Lay Scientist. The full story of “The Lenski Affair” can be found here.

Getting back to “childish nonsense”, Schlafly’s approach will be very familiar to anyone who has ever had a child, or who remembers their own childhood. That is, if the other nasty boys and girls won’t play the game the way you insist they should, then you just set up your own sand-box and invent your own rules.

Whether you can actually find anyone else apart from yourself to play according to your rules is another matter.

Which brings me to another familiar trait of CAM; the idea that you can disregard reality when it conflicts with your magic, and instead insist that a parallel set of physical laws should apply whereby your magic DOES work.

If it ducks like a quack…

An almost invariable corollary of this insisting on your own special reality is taking offence, and sticking your fingers in your ears, whenever anyone points out that your position is inconsistent with the facts.

Or, indeed, insisting that nasty “skeptics” should be excluded – see above.

But there is a catch.

Sometimes, what you write is far better at making you look idiotic than anything your opponents could come up with.

For instance, let’s see what the CAM people write about their new Wiki4CAM project:

“We need a place where the CAM community can build its own knowledge base without the undue interference of skeptics… a place where the CAM practitioners themselves write articles and create a true picture of its history, development, efficacy and positive research.

… We will try to ensure that this wiki gives the CAM community the most conducive atmosphere for creating its knowledge base. This wiki is open ONLY to CAM practitioners.We strongly discourage skeptics from registering here. Anybody found posting any anti-CAM data will be quickly removed.

Now perhaps, like me, you did a double-take when faced with this. Is it a put-on? After all, take the line a true picture of [CAM’s]…efficacy and positive research.”

Now, anyone who reads the Cochrane reviews on CAM therapies, or looks at the assessments in the NHS CAM Specialist Library, or who has read any of Edzard Ernst’s work, will know that there is precious little reliable evidence of efficacy for most CAM therapies. And also that most of the “positive research” comes from small, and methodologically poor studies, or even from customer surveys. And that, in almost every case where there is enough research to tell, the rule seems to be that “the better quality the study of a CAM therapy is, the less evidence there is for any effect beyond placebo”.

But… it seems clear that the folks at Quackapedia are not pulling our leg. We must conclude that no irony is intended, and they are completely serious.

Which brings me to a central point:

Isn’t it striking how practically every statement the Alt-Med crew make – and it is especially true when they are talking to each other, rather than reciting the neutral-language mantras about “integrative medicine” to sugar-coat it for the politicians – hammers home the central point that they do not understand how the scientific process (in its broadest sense) works?

Orac sums this up beautifully in his post about Quackapedia:

Of course, I find it most hilarious that the homeopaths setting up Wiki4CAM explicitly and openly state that they will censor any “anti-CAM” (read: actual scientific) data posted to their Wiki. A more explicit statement of what CAM is about when it comes to science I have never seen. In marked contrast, we in the business of scientific medicine don’t have the luxury of censoring criticism of our therapies, whether those criticisms come from within or without medicine. We have to deal with them, whether they are good science or spurious. That CAM practitioners are too afraid to deal with skepticism and science shows that they are neither skeptics or scientists.

Quite.

The overwhelming majority of CAM practitioners I have encountered and/or debated reject science, or meaningful testing. They are about belief, and the idea that believing in something fervently enough means that it must be true. “Your tests must be wrong”, they state, “because they contradict what I KNOW to be true.”

Though most CAM therapists are sincere in their delusions, this is one of the first principles of lying: say it often enough, and loud enough, and with a straight enough face, and never deviate from it, and eventually people will give up asking you the question. Even better, if you go on insisting black is white long enough and with sufficient conviction, then some people you are shouting at will waver and begin to concede that the black might actually be grey – or that what looks black might be white in an alternative reality.

My reality, your reality, his reality…

One of the things I will be most curious to keep an eye on over at Quackapedia is how they deal with Woo-therapies which are effectively mutually incompatible.

Perhaps the most obvious example of this is in the Woos’ obsession with oxygen and “oxidative stress”. In one part of the Woo pantheon, oxidative stress, and free radicals, are baddies, and the woo response is typically to tell you to chomp bucketloads of anti-oxidant supplements, typically starting with several grams a day of Vitamin C and adding selenium, Vitamin E and half a dozen or more other ”special antioxidant phytonutrients”

The crib version: Antioxidants GOOD. Oxidative stress mucho BAAAD.

Meanwhile, in a different part of the Woo-niverse, people are being “treated” (though, as usual, with zero evidence for efficacy) with 100% (pure) oxygen or even hyperbaric oxygen (oxygen at higher than atmospheric pressure). And even O3, ozone (trioxygen). And madder still, hydrogen peroxide (H2O2) – a truly quack-a-licious H2O2 therapy page can be found here. [And a Quackwatch round-up of idiotic “oxy-therapies” touted for cancer specifically is here.]

Now, you may say that I am being unfair here, and sometimes in conventional therapy what is good for you in one setting is bad for you in another. That is a fair point. But in those cases, there is an underlying rationale with a plausible basis in physiology. For instance, it is possible to explain why a lot of oxygen is useful for some specific things, and less oxygen for others – e.g. hyperbaric oxygen to remove (compete off) carbon monoxide tightly bound to your haemoglobin in carbon monoxide poisoning, or during hyperbaric treatment for decompression sickness (“the bends”), and hypobaric oxygen to try and induce ”Altitude Adaptation” (not a medical treatment, but widely used by rich athletes training for endurance events, often in so-called ”Live high, train low” regimes).

There will also be proper trials to assess how beneficial these interventions are, and what the unwanted effects are, when giving different amounts of oxygen for different conditions and in different groups of patients (brief intro on Wikipedia here). In fact, even though getting patients to breathe oxygen is a very common medical intervention for all kinds of things, there continues to be rigorous examination of whether it is useful, and of precisely how much O2 to give: should it be 100% or 40%? How many litres a minute? Should it be given by face mask or by nasal prongs? And so on, and so on.

In Woo, of course, none of this applies. Typically, vague symptoms of fatigue and malaise (or, as we people over 35 refer to it, “life”) are attributed to “stress” and you are told to take a ton of antioxidants.

Unless, of course, you have consulted a practitioner of hyper-oxygenation, ozone or H2O2 therapy, in which case your symptoms could well be attributed to “inadequate oxygenation”, and you will be told you need more oxygen, or possibly a “oxygenating flush” or “artery cleansing” with H2O2.

Basically, in this real-world Alt.Health.Reality scenario, the only determinant of what idiocy you end up with will be what sort of snake-oil that particular practitioner sells.

Homeopathy… Traditional Chinese herbs… Acupuncture… Reflexology… Ozone therapy… Colonic cleansing…

…etcetera etcetera.

Pick a Woo… Any Woo…

Rather weirdly, to my mind, all these people find all the others’ therapies equally valid.

Basically, it seems to be non-PC in Alt Reality to criticize someone else’s Alt Reality.

The only thing you have to be opposed to is those evil doctors and scientists with their “Big Pharma toxins” and “slash, burn and poison”.

(note that even this is not true when your special “natural” vitamin supplement, e.g. Coenzyme Q10, is in fact made by a big pharmaceutical company, as many supplements are- but I digress).

Yes, the Woo credo of Universal Acceptance of Woo means that, by a special kind of “Doublethink”, even Woo-beliefs which completely contradict one another can co-exist.

Which is completely inconsistent in a scientific sense – but completely consistent in a reality-free sense, which is where most Alt Therapies live.

The rationale is simple:

Once you have invented ONE parallel reality, why stop there?

Some readers may recall that in an earlier post I wrote my own advertising tag-line for homeopathy:

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

And – to take this idea a bit further, if my Woo-niverse and your Woo-niverse are irreconcilable, don’t worry, because in the Woo Multiverse they can ALL co-exist!

How is this remarkably agreeable state of affairs achieved?

Easy. As all true Woos know, all you have to do to justify it is to wave your hands and invoke quantum theory.

Goodnight. And may your Personal Physical Reality go with you.

[BPSDB]

The Multi-Coloured Golf Umbrella

August 6, 2008

This week saw the death of arguably the 20th century’s greatest novelist, and certainly one of its moral consciences, with the passing of Aleksandr Solzhenitsyn [1]. Solzhenitsyn was also a mathematician and physicist, teacher, and most famously a political prisoner in the Soviet Gulag.

Although the first Solzhenitsyn I read was One Day in the Life of Ivan Denisovich (required reading for school kids studying Russian back in the days when we still had a Cold War), the book that I have re-read the most over the years is The First Circle. The Ukranian Professor down the corridor from me insists this is actually a lazy translation of the Russian title, “V krugye pyervom”, which means “In the First Circle”. The title is a literary allusion to the First Circle of Dante’s Hell in The Divine Comedy. As Wikipedia puts it:

“[In] Dante‘s first circle of Hell in The Divine Comedy … the philosophers of Greece live in a walled green garden. They are unable to enter Heaven, but enjoy a small space of relative freedom in the heart of Hell.”

The small space of Solzhenitsyn’s First Circle is a special prison, or sharashka, where an assortment of engineers, scientists, mathematicians and philologists – all prisoners of the Soviet state – work on special technical projects for the Soviet Interior Ministry or MVD. So – a slave labour camp for scientists. Perhaps it is this which has me re-reading the book every so often. Many of the characters in The First Circle are recognisable scientist types, trying to find some escape, and some reason to carry on, in the technical problems that they are set by their work, and in the fellowship of scientific colleagues. Solzhenitsyn’s early training as a mathematician and physicist explains how he ended up in the sharashka (the character of Gleb Vikentich Nerzhin in The First Circle is autobiographical) some time after his original arrest for writing a letter criticizing Stalin.

Solzhenitsyn is not what you would call a humorous writer, but there is a black humour in his work. He, and his characters, are ever alive to (usually bitter) irony.

So after the preamble, here, as a small personal tribute to Solzhenitsyn, is a short piece written by a friend of mine who uses the pseudonym “Mark Cain”. It was originally written as a Christmas Story for the magazine Physiology News. The story is set in a modern British University, but is a kind of homage to Chapter 54 of The First Circle, “The Smile of the Buddha”. Read the book (which you should anyway) to see why.

Anyway, without further ado:

———————————————————————————————-

The Multi-coloured golf umbrella

By Mark Cain

Once upon a time, a few years ago, and somewhere in the UK, there was a medical school – a fairly typical one. The medical school building was showing its age. The drains and sinks stank, especially after the ventilation was turned off at 5.30 pm. The smell of phenol-chloroform mixture would often waft down from the molecular biology labs upstairs. The cleaners came every couple of weeks to re-arrange the dust on the floor, but avoided the really nasty bits under the benches, and also most of the labs (too hazardous). The tops of the 1970s wooden benches were thick in accumulated sticky grime, because there were no technicians left to clean them (cut-backs and voluntary redundancies). And it was always dark. The windowless corridors were gloomy. Even the light fittings that worked had only half the number of fluorescent tubes they were made for, since every second tube had been removed in an early 80s ‘electricity economy drive’. So half the proper number of flickering, bare, fluorescent tubes shed a sickly light as the workers scurried along.

Then, one day, strange things started to happen.

First, extra cleaners started to appear – or at least, the same cleaners appeared more often. Rubbish was removed every day. Corridor floors were scrubbed and polished every week – even the dark corners that were usually ignored. Posters and notices stuck on the doors and walls were pulled down, and the lab staff sternly admonished not to put them up again. The next week painters came and repainted several corridors in sunny yellow-white tones, rather than the usual institutional pale green.

The staff was surprised, and asked each other what it could all mean.

Next, something truly astonishing happened. A man in brown overalls appeared, and began to put fluorescent tubes back in the light fittings. Not all of them, to be sure, but all the light fittings in the main corridors. And then he started re-fitting the diffuser panels to the light fittings.

The staff was amazed. The light fittings had had no diffuser panels since half the tubes had been removed all those years ago. Where had these diffuser panels come from? Had they been hidden away somewhere for the intervening nigh-on two decades? Had they been specially cleaned? Were they new? And what did it all mean?

And then – the rumours began to circulate. An Important Visitor was expected, people whispered. More than merely Important – a VERY Important Personage altogether. Though no-one knew when, the unusual events gathered pace. The grass in the building quadrangle was cut, and all rubbish bins were emptied twice daily. Extra cleaning patrols scoured the building picking up stray food wrappers and crisp packets. The windows and glass doors at the medical school entrance were cleaned and all the signs renewed. The battered chairs by the reception area were replaced by ones newly re-covered in bright floral fabric, and fresh flowers in a vase appeared on the reception desk.

Finally, it was whispered that the senior secretary had been seen coming into the building with two brand-new, especially-large, multi-coloured golf umbrellas.

The great day came at last. A convoy of chauffeur-driven government Jaguars arrived, disgorging the Very Important Visitor, his assistants and his security men. A thin rain was falling, but the Very Important Visitor reached the front door without a single raindrop touching him, thanks to the resourceful chief secretary and an assistant wielding the multi-coloured golf umbrellas. The Important Visitor and his entourage passed rapidly down a pre-planned route through the medical school’s well-lit and re-painted corridors. They stopped briefly to look at the newest refitted laboratory, where they were greeted by several senior professors wearing white coats. (When photographs of this historic occasion later appeared, everyone agreed it was the only time they had ever seen the professors wearing white coats.) After ten minutes of photographs in the lab, the Important Personage, his retinue, and the professors proceeded to the site of the new medical school annexe. Here the Important Visitor donned a hard-hat and posed for more photographs with a ceremonial pickaxe and several important university administrators, including the University Vice Chancellor. Pausing only to tell everyone how immensely impressed he was, the Important Visitor and his entourage returned to their cars and left.

The next day, staff entering the medical school building saw that the flowers were gone from the reception desk. On their way to the labs they passed a man in brown overalls, who was removing every second fluorescent tube from the light fittings in the main corridors. Soon life returned to normal. The floors went back to a fortnightly clean. The piles of undisturbed dust returned to the corners, barely visible in the half-light. The drains smelled as bad as they ever had. The pictures of the Very Important Person with the University Vice Chancellor and the senior Professors appeared in the university newsletter a week after the visit, but they were soon forgotten too.

Before long, people began to wonder if it had all been a dream. Some even said it had been. Apart from the new annexe building going up next door, everything in the medical school was exactly as it always had been.

Except for one thing.

In the corner of the chief secretary’s office, leaning against the wall, stood an extra-large, multi-coloured, golf umbrella.

————————————————————————

[1] Alexsandr Isayevich Solzhenitsyn, decorated soldier, political prisoner, teacher writer and Nobel Laureate, born December 11 1918; died August 3 2008. His Guardian obituary is here, and one from The Times here.

.

Otherwise engaged

August 4, 2008

Dr Aust has not been blogging much lately.

Well, actually Dr Aust never blogs all that much, being much better at ranting off-the-cuff in the comments threads of other peoples’ blogs (thanks again, Holfordwatch, Orac, Dr Crippen at NHS Blog Doctor, Ben Goldacre and David Colquhoun) than at penning considered well-researched essays (too much like work). Another problem is that, like many ageing academics, Dr Aust likes to take his time writing things. And to make sure that what is in them is (mostly) accurate. Sadly, this takes time, which is rather at loggerheads with topicality. Blogosphere stories go round the world like waves, and are often seven day wonders. So by the time Dr Aust has got round to laboriously concocting a comment, the Bad Science Blogoverse has usually moved on. And typically several other people have already covered whatever-it-was far better than I would have done.

As a result, quite a few Dr Aust posts that are lengthily gestated never actually reach the point of delivery.

Which brings me, in a desperately tortured link, to the more specific reason why I haven’t finished anything for the blog recently.

It’s a boy

Yes, Dr Aust and Mrs Dr Aust have recently taken delivery of our second child, henceforth “Baby Aust”. Baby Aust (who is a he) arrived just over a week ago, after a rather short time in hospital (just under two hours “door to floor”), but following the usual nine months, plus a few days past due, of angst-y anticipation – and also following about eighteen hours of uterine contractions, though according to Mrs Dr Aust it was only the last four or five hours that really hurt.

The contractions started, as they frequently do, at around 2 am, though Mrs Dr Aust – who is a stoic sort – soldiered on through most of the next day pretty much as normal. We made it to hospital in the early evening, having cooked an early dinner and then deposited a mildly protesting Junior Aust with relatives. Mrs Dr Aust was finding it rather difficult to eat between the by-then distinctly painful spasms, but after last time we know the food at the local hospital only too well, so we figured it was eat now or not at all.

Dr Aust’s main (only?) contribution was to drive to the hospital without crashing the car, while Mrs Dr A sat in the passenger seat making strange noises and sinking her nails into the dashboard trim. Thankfully the Aust-mobile is over ten years old, and was a cheap-as-you-can-get box on wheels to start with (who says scientists don’t make the big money?) so the damage will not have decreased its current market value of zero pounds.

Hard labour

The birth itself was a contrast to our previous time a few years back. Junior Aust’s arrival was very high-tech, a past due induction of labour, with painful labour for nearly a dozen hours, epidural anaesthesia, full-bore Syntocinon (synthetic oxytocin) drip, and continuous electronic monitoring of uterine contractions and foetal heart rate.

This time was quite different, as we were shown into the “active birthing suite” – a bit like a hotel room, complete with sofa, en-suite kitchenette, CD player and whale music CD, large padded floor mat and a kind of giant inflatable exercise ball. Although we passed on the whale music, all went smoothly, and something less than 90 minutes later, there was Baby Aust, looking somewhat jaundiced (literally and figuratively), but otherwise fine and with all his bits in the right places.

Birth – all very political

Now, apart from ending up with a caesarian section, or an instrumental delivery (which we probably avoided first time around by about twenty minutes), one could not really have had a more “medicalised” techno-birth than our first time. And apart from a water birth in a darkened room, or a home birth, one could not have had a much more “minimal intervention” delivery than our second one.

I have to say, though, that I honestly couldn’t tell you which one was “better”. Well, of course, I’m only a bloke, so what would I know.

So – I asked Mrs Dr Aust which one was better. And she, too, says she has no opinion one way or the other. All she said was “Well, I was pleased it was quicker this time”.

Thinking about it, we are of the joint opinion that the only thing we cared about was having a healthy baby – which we have, thankfully. All the other stuff that is nowadays ringed around the experience of childbirth just seems like… baggage. So to us, the two very different experiences were equal in terms of THE THING THAT ACTUALLY MATTERS.

Which makes me wonder why modern childbirth is an issue that provokes such tremendously heated arguments. Examples are home birth versus birth in hospital, pain relief or not or what, midwives versus doctors (for the record, we had both Junior Aust and Baby Aust in a midwife-led delivery unit with one-to-one midwife care and on-site consultant-level medical cover, though we never saw a doctor during either delivery) and even independent midwives versus NHS ones.

The things that seem to prod people away from hospital births (a line that some advocates pursue with missionary zeal), are bad experiences of hospital care, fear of “medicalised” birth, and sometimes an ideological drive to “de-doctor” the process.

Now it is hardly news that NHS maternity care is not 100% marvellous in every respect. While our experience of the local delivery suite and its staff has been brilliant, I have to say that the pre-natal and post-natal wards left something to be desired. The food is bad. The wards are inevitably noisy and make sleep difficult to impossible. You have to wait ages for things to get done. But… how big a problem is being stuck hanging around for a few hours waiting for the paediatrician to show and do the routine next-day check on the baby?

Irritating, certainly. Stressful, perhaps.

Life or death – hardly.

In the end, the only thing we cared about both times was ending up with a healthy baby. And the most logical place to choose for that seemed to be a hospital delivery suite, with access to the full panoply of medical back-up just in case the sh*t were to hit the fan.

Of course, I know people who have taken other views, including among the neighbours in our nice middle-class enclave, and among friends of friends. I have known a couple of people who fought to get homebirths when the doctors and midwives advised against it. These pregnancies ended happily, with healthy babies and happy parents.

But does that prove that home birth is as safe as the advocates tell you?

I have also known people who had complex pregnancies and births, up to and including serious trouble that was life-threatening to mother and baby. If some of these folk had not made it promptly to well-equipped hospitals with specialist maternity care, Special Care Baby Units and Adult Intensive Care, the outcome would likely have been dire. And I used the word “dire” there euphemistically – you can say “dead” if you prefer.

So does that show that you would be mad to give birth at home?

It’s the statistics… again

As so often in modern healthcare, the devil is in the detail. The medics will tell you that homebirth statistics loudly quoted by homebirth advocates to show that homebirth is safe are misleading, because the people having homebirths are mostly a carefully-selected population of low-risk mothers; youngish, in excellent health, and often having second or third children after having had a normal delivery with a first baby. (The point, of course, being that this is predictive of a low likelihood of complications). In addition, pregnancies slated for homebirth, but where indications of “non-uncomplicated-ness” appear at any point, will often be “re-routed” to be hospital births for safety’s sake. The result, say the doctors, is that the “birth at home is safe” statistics you get quoted are not representative of a general population of the women giving birth in the UK. The homebirth advocates, unsurprisingly, dispute this analysis.

One interesting (though anecdotal) thing – Mrs Dr Aust and I know an awful lot of female doctors with children, and we only know one who opted for a home birth. Are all the others brainwashed? Or just careful?

So you could say that, at bottom, it is a matter of statistics. And, once you have the statistics, of your personal beliefs about, and attitude to, risk. And, critically, your view of the relative importance of the things you are risking, or weighing up.

Unless, of course, you pick the ideological view first – perhaps, the kind of “birth experience” you want -and then select the statistics that match the ideology. In which case, you are not REALLY making your decision looking primarily at the risk at all.

Now, I would say I am relatively ideology-deaf, but I am pretty risk-averse. And Mrs Dr Aust, being a doctor, is extra super-duper risk-averse. When it came right down to it, “Why take the chance?” is very much the way we looked at it. So hospital birth for us, thank you very much. And we are very happy with how it turned out, both times.

Because, when all is said and done, it is ending up with a healthy kid that matters. Not whether there was a CD player and candles.


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