Archive for September, 2008

I smell something iffy.. or should that be fishy?

September 27, 2008

“I smell something iffy

Quite distinctly fishy

Durham‘s special trial ishy*

When nurr vote got done…”

(With apologies to Alex Glasgow, David Fanshawe, and North-Easterners in general.)

*”Initiative”

In a strange bit of synergistic convergence, the very week that I found myself reading a Ph.D. transfer report dealing with fish oils (of which more later), the Durham Fish Oil Zombie rose from the dead to haunt the national press once more.

The Fish Oil Zombie story (a.k.a. “Fishy Business at Durham Council”) is one of the things that first got me commenting on Ben Goldacre’s Badscience blog over two years ago. I know the story is old, because I started using it as a 1st year student exercise in spotting bad science back in the 2006-7 academic year.

If anyone doesn’t know the history, the place to start is over at Bad Science on the Fish Oil category tab, where you will find the whole history and all the posts. But it is worth pointing out that the Fish Oil Zombie story attracted attention in part because it seemed to epitomize all the things that are bogus about the promotion of unproven nutritional supplements.

Yes, the Fish Oil Zombie story had it all.

To list a few only:

- “Pills for Ills”, with shiny capsules as a solution for social problems;

- PR spin masquerading as scientific investigation, and “Big Quacka” bullshit;

- the co-opting of public servants (with their apparently enthusiastic connivance) by the clammy embrace of the fish-oil salesmen and the desperate pursuit of column inches;

- a large experiment on a load of kids without anything like “ethical approval”, and indeed without Durham Council ever having formally voted on it;

- the public, and especially the parents and children of Durham, as pawns and dupes;

- a “cover story” from Durham Council’s PR flacks that seemed to change every day

- and – above all – reams of fawningly credulous press coverage.

Ben Goldacre’s Guardian column today nicely summarises both the background and the recent revival. The short version is that, having eventually admitted that their “study” / “initiative” / publicity stunt could in no way be described as a piece of science, Durham Council’s Dave Ford (ex Chief Schools Inspector for Durham and now “Head of Achievement Services”) and Dr Madeleine Portwood (Chief Educational Psychologist and enthusiastic conference attender) have now – eighteen months down the track – magicked up some data.

Ben Goldacre has already pointed out exactly why Durham’s relentlessly massaged figures don’t show anything in their new form, just as they showed nothing when the GCSE results appeared; the “study” “Initiative” trial was incapable of producing reliable data, because it was designed that way from the outset. It was, from Day One, a PR stunt and a piece of let’s-be-seen-to-be-doing-something-ness. And all the post hoc finagling in the world can’t change that – or make a silk purse out of a sow’s ear.

The shorthand for this, in science as in many other walks of life, is:

“Garbage in – garbage out”

Or: if you run a study giving kids fish oil capsules with no control group, you cannot reach any meaningful conclusion on whether the fish oils do anything, regardless of your (claimed) sample size.. This is, as they say, not exactly rocket science.

More interesting than the details of this rather desperate attempt to generate a bit more PR and publicity out of re-animating the Fish Oil Zombie is the timing.

I don’t mean the full moon, or the approach of Halloween. I mean the fact that the Zombie has risen from the grave precisely three weeks before the ”Food for the Brain” conference in London, organised and promoted by fish-oil friend and enthusiast Patrick Holford’s crew… and at which Portwood is scheduled to give the assembled Nutritionistas The Word From Durham.

Oddly unmentioned in the recent stories is that the fish oil capsules in Durham’s trial “Initiative” were provided free by the fish-oil manufacturer Equazen. The FFTB conference is being run by Dear Patrick’s acolytes (FFTB and the supplement company Biocare), but is also supported by Equazen.

Biocare, of course, is the company where Mr FFTB, Patrick Holford, is Head of Science and Education, according to the gang over at Holfordwatch. Biocare sell an extensive range of fish oil products. And Patrick’s face, name and endorsement are on lots of branded fish oil products too.

Equazen’s website front page prominently states:

“EyeQ [Equazen’s fish oils] used in Food For The Brain Schools Campaign” and:

“The Omega Oils used in the Durham Schools Trial”.

Indeed, the line

“Omega-3 fish oils including Eye Q Proven in the Durham Schools Trial”

turns up on Google whenever your search lights upon “equazen.com”.

In other words – it’s a very small fishy old fish-oil world.

Or… evidence, once again, that everything Evil Big Pharma can do – e.g. run “vanity PR” meetings with hand-picked speakers, all designed to act as a surreptitious plug for the company’s drug(s) and message(s) – “Big Quacka” (“Big [Fish] Oil”…?) can, and does, do as well.

There will, of course, be some real scientists speaking at the FFTB meeting – for instance Dr Joe Hibbeln of the US National Institutes of Health. No-one is saying there shouldn’t be fish-oil research. What scientists and skeptics are saying is that there should be good research, done properly, so that we can get some real idea whether fish oils are any good for anything.

Which brings me to my Ph.D. transfer report.

The thesis concerns two things – a smallish human study on the use of fish-oils to reduce cardiac arrhythmias after surgery, and a feeding study in rats to see whether fish oils alter cardiac cell electrical parameters.

This human study, the Ph.D. student told me, was to repeat one that had been done in another country that had shown apparent arrhythmia-reducing effects of the fish oil. He was repeating the study, he said, to check if the effect was real, to check if the effect was as big as the other workers had reported, and to look at whether any clues could be got as to the basis of any effect. This last bit would be done by making sophisticated measurements on ion channels and hormone receptors in small samples of tissue that are routinely taken from the heart during surgery.

As we were discussing the work, I asked the student (who is actually a Cardiology Registrar – a doctor training to become a consultant – taking some years out to do a Ph.D.) about the blinding in the clinical study. The study was double blind, he explained. The oil was given as a capsule, containing either fish oil or olive oil. The patients were asked to swallow it whole, so that they got no taste of the oil in the mouth. As the primary experimenter, he would not know who was in which patient group – who got fish oil and who didn’t – until the study ended after about three years. We talked for a bit about whether there was any way the patients might work out which group they were in (“fishy burps”, for instance – nice), and other issues of the experimental design.

The rat study, too, has the main experimenter (our cardiologist again) blinded as to whether the rat whose cells he is studying had been on the fish oil-supplemented diet, or on a “placebo oil”. Once again, he will not know until the study finishes which animal was which.

Now, these designs are not absolutely perfect, but what they testify to is the desire of scientists to get the answer as free as possible from “confounding effects”. These include “expectation effects” – the tendency of experimenters to see a result when one isn’t there, because they want there to be a positive outcome from the study.

Note, also, the repeating of the earlier clinical study. When something potentially interesting shows up in the scientific / medical literature, the first thing people want to know is – is it real?. So it will get repeated by other investigators in other labs, on other patient populations, in slightly different ways, and so on. It will be confirmed, or sometimes disproved.

Small clinical studies, though, can only tell you so much. They need to be tested on a larger scale. So the next step, if something looks promising in several small trials, will typically be a much bigger study, usually on multiple sites, to look at whether the possible therapy holds up in a bigger patient group, perhaps with more diverse characteristics (age, extent of any disease, diet and so on). Any such bigger study will have to go through extremely extensive ethical approval (is the study and what it asks patients to do justified on the grounds of the benefit likely to be derived? Is it safe?). The big study will also have to have as good a blinding procedure as can be devised, and so on, and so on.

Slow and a bit plodding, perhaps, but all exemplifying the desire to find out the truth about whether the stuff really works. And reflecting, as ever, the desire not to fool oneself:

“The first principle [of scientific integrity] is that you must not fool yourself – and you are the easiest person to fool” – Richard P Feynman in his lecture on Cargo Cult Science

And if we are ever going to get real answers on fish oils, that is the kind of work we need. Proper study design; proper blinding; proper data analysis; professional investigators.

In contrast, what we don’t need is PR-over-spun garbage, designed to polish up peoples’ and companies’ public images but devoid of any scientific usefulness whatsoever.

Ben Goldacre is continuing to campaign, via his Guardian column and blog, for journalists who write about science and health stories to take the fairly elementary steps to be able to spot the difference.

Let’s just hope his message is getting through.

[BPSDB]

Sing it: Woo is all around

September 24, 2008

Yes, more musical entertainment (?). As I sat trying to compose something serious last night, this appeared instead… enjoy (?)

Woo is All Around (The Alternative / Placebo Therapist’s song)

(tune: ”Love is All Around” by The Troggs)

I feel it in my fingers

I feel it in my toes

The Force is all around us

And so my income grows

It’s written on my website

It’s ancient healing lore

So if you all believe it

Bring me any bit that’s sore

———————————————

You know I can help you, I most certainly will

I’m not a harassed doctor or a Pharma Shill

There’s no beginning,
There’ll be no treatment end
’cause on your naivety I can surely depend

————————————————

You’ve told me all your problems

And I’ve looked most concerned

Now I’ll dish out some Placebo

Whatever New Age crap I’ve learned

There’s probably nothing wrong with you

(Which won’t reduce my fee)

But if you should feel better
I’ll say that it was me (oh yes I will)

————————————————

(You know) I look sympathetic, and I always will,
It works most excellently

‘Til you’ve paid off the bill
There’s no beginning,
And there’ll be no end
’Cause on your neediness I’ll happily depend

————————————————-

I wouldn’t call it lying

If I tell you it’s all real

Because if both of us believe it

All that matters is what we feel

It’s what the punters want, mate

(And) It’s all over the press

And wouldn’t it be better

If you got it on the NHS (oh yes it would)

————————————————

(You know) I look sympathetic, and I always will,
It works most excellently

‘Til you’ve paid off the bill
There’s no beginning,
There’ll be no end
’Cause on your cheques I’ve come to depend

————————————————-

I feel it in my fingers
I feel it in my toes
There’s one born every minute
And so my income grows

(repeat last line to fade)

————————————————–

Alternatively:

Repeat entire song ad infinitum.

- Or until the money runs out.

[BPSDB]

What say the Nutritionistas?

September 18, 2008

In which we ponder why the “Nutritional Therapy Community” has been silent on the Goldacre-Rath libel case.

There is no doubt that Ben Goldacre and The Guardian have won a great victory for rationality and truth in their legal battle with Matthias Rath. Both should feel very proud for standing up to be counted. The fact that they defended Rath’s lawsuit under UK libel laws (notoriously friendly to plaintiffs) makes it all the more impressive. Given the potentially serious financial downside of losing a suit like this, newspapers often prefer to take the complained-of material down and settle out of court. It is to The Guardian’s great credit that they did not do this. As a regular reader for 40 years (honest) I feel the paper has justified the loyalty we leftie liberal sceptics feel towards it.

Hopefully, the judgement will see the release of a lot of new material about Dr. Rath, and particularly about his campaign to promote his vitamin concoctions to HIV-positive people in Southern Africa. The next instalment appeared in The Guardian on Monday. This second piece emphasised again the terrible human tragedy of the AIDS crisis in Southern Africa. A whole motley crew of quacks have appeared to exploit the vulnerability of those who are poor and HIV positive. Encouraged and aided by the ignorance and ideology-driven blindness of the South African government, these chancers (who come in both local and international varieties) have been able to generate a thriving trade, at a terrible cost in wasted lives.

What other things can we take from the judgement?

One point that has been made by several bloggers is that the silence from other “nutritional therapists”- including ones with high media profiles who have been known to use lines somewhat reminiscent of Rath’s – has been total. Now why is that?

Rath, of course, has been something of an Alternative Medicine rock star, touring the world giving three-hour speeches to packed halls. This is a touch surprising, since even a cursory reading of some of the vast mass of material on Rath’s myriad websites (e.g. here) reveals a lot of deeply weird stuff. I would be tempted to generate an extended post on “Matthias Rath in his own words” were it not for the fact that several such are already out there in the blogosphere. Anyway, to save time, The Guardian summarises several of Rath’s more oft-repeated accusations as follows:

“Rath could not have been clearer in his message in a campaign waged on the internet, in speeches across the world and in adverts in the New York Times: [anti-retroviral drugs] were a form of genocide against Africans, produced by drug companies responsible for the second world war, apartheid and the US invasion of Iraq.”

This in addition to Rath’s core message for the last fifteen years, namely that all cardiovascular disease is actually a vitamin deficiency (lack of vitamin C), and that people are deliberately kept in ignorance of this so that the “Pharma Conspiracy” can sell us their expensive drugs.

These accusations are not hard to find on Rath’s websites. And if that was not enough, there is his campaign to publish “Open Letters” as paid adverts in major newspapers – a selection of these can be found here.

Given the bizarre, not to mention barking mad, nature of much of this stuff, you would think many of the CAM and nutritional medicine folk – at least at the less way-out end of the “natural health” spectrum – might have sensed ”something of the night” about the charismatic Dr Matthias. However, they mostly seem to have viewed him as a hero, most probably for his “refusal to be intimidated” by conventional medicine and “Evil Pharma”.

(Translation: his ready recourse to M’Learned Friends in the case of any criticism, and the flamboyant way he has pumped out his message about how the PharmaCos conspire with governments and conventional medicine to “promote disease”).

It would seem, then, that to many in CAM Rath has been a sort of “six hundred pound gorilla”, prepared to fight the good fight for their side. A strong thread runs through many forms of CAM, increasingly so the wackier the therapy, that the practitioners and advocates are truth-seekers being “persecuted” by the force of reaction (conventional medicine and science, and/or the “Big Pharma Conspiracy”). This leads to such ludicrous things as “Health Freedom” campaigns, which largely amount to demands for the “human right” to get quack therapies paid for by public fund. Rath’s message chimes strongly with this strand of belief, and his celebrity and charisma lets people of this mindset see him as a hero, rather than a person whose weird beliefs and statements might lead you to wonder if he is losing the plot.

Of course, this highlights a key difference between CAM and the mainstream.

In the mainstream, if you are found engaging in wholly unethical practices (and/or repeatedly lying to your patients if you are a physician), you can expect to be investigated, exposed, disciplined, and potentially thrown out of “the business” for good.

If your scientific or medical evidence is found to be faked, bogus, or exaggerated, ditto.

If your science is found to be genuinely done but incorrect, you can expect to see people picking holes in your arguments, discussing your mistakes and why and how you made them, how to avoid similar errors in future, what better ways to do things are there, and what we can learn from it all.

In contrast, in far too many alternative medicine communities, none of the above happens.

So what might we expect from the “nutritional therapy” community in the wake of the court case, and the Guardian’s reporting of Rath’s activities?

In particular, what should they be saying about Rath’s attempts to use the libel laws to suppress scrutiny of what he does?

If they had any genuine ability to self-regulate – and this, remember, is something that nutritionists and other CAM practitioners are repeatedly telling the Government they are ready and keen to do – they should surely be speaking out about what a bad example Rath has set.

They should be admitting how what has been happening in South Africa bears out almost everything the sceptics and bad science watchers have said about the worst excesses of unlicensed nutritionists and nutrition companies.

They should be setting out how they would devise codes of practise for nutritional supplement manufacturers and nutritional therapists that would try and prevent these kind of abuses.

They should be insisting on open debate, on the scientific facts, and condemning the use of defamation law as a gagging tactic in matters of science and medicine, real or “alternative”.

Instead, what we have is silence.

A whole lot of silence.

Let’s hope the nutritional therapists in particular are using this silence to take a long, hard, look at themselves.

But somehow, I am not optimistic.

[BPSDB]

Shake it, baby, shake it

September 8, 2008

In which homeopathy (spelling optional) gets a new theme tune (and it even rhymes).

If I could have had any talent I wanted, I think I would most like to have been able to write witty satirical comic songs, like my musical comic hero Tom Lehrer.

Unfortunately I have only ever been able to be snide in a small and juvenile way, but you make do with what you have.

Today was a quiet day in Dr Aust’s office. Summer has gone – you can tell because it has stopped raining – the conference season is pretty much over, and there are still a couple of weeks until the students return. Anyway, as I sat there at 4.40 pm, wondering if it was early enough to go home, something came drifting unbidden into my head.

First came an old tune

…and then the words.

So without more ado I give you:

———————————————————–

The Homeopath’s Song (Super calibrated shaking)

(with apologies to the Sherman Brothers and Mary Poppins)

———————————————-

Super calibrated shaking makes the magic potions

Even though the logic here is frankly quite atrocious

If you say it loud enough you’ll always sound precocious

Yes super calibrated shaking makes the magic potions!

————————————–

Um diddle diddle diddle um diddle ay

Think of Sam Hahnemann shaking away

————————————–

Because I learned some chemistry when I was just a lad

Our complementary therapist said I was very bad

But then one day I learned something that saved my aching brain

If you embrace parallel reality this can be your refrain:

—————————————————

Oh – super calibrated shaking makes the magic potions

Even though the logic here is frankly quite atrocious

If you say it loud enough you’ll always sounds precocious

Super calibrated shaking makes the magic potions!

——————————-

Um diddle diddle diddle um diddle ay

Think of Sam Hahnemann shaking away

———————————–

I like to talk and theorize to sound quite erudite

Invoking Quantum Theory in terms most recondite

So when crowned heads and celebrities consult me for their health

I can sell them magic water and relieve them of their wealth

————————————————

Oh – super calibrated shaking makes the magic potions

Even though the logic here is frankly quite atrocious

If you say it loud enough you’ll always sounds precocious

Super calibrated shaking makes the magic potions!

—————————————————————

Um diddle diddle diddle um diddle ay

Think of Sam Hahnemann shaking away

Shout until it makes you hoarse

Disturbance in the Vital Force

Um diddle diddle diddle um diddle ay

Um diddle diddle and shake away

———————————————-

So when the scientists put you down there’s no need to dismay

Just summon up this magic phrase and you’ll have lots to say

But better shake it carefully or it may make you ill

For with too much wristy potentizing ignorance can kill

—————————————————-

Oh – super calibrated shaking makes the magic potions

Even though the logic here is frankly quite atrocious

If you say it loud enough you’ll always sound precocious

Yes super calibrated shaking makes the magic potions!

———————————

(repeat ad nauseam)

[BPSDB]


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