Dr Aust's Spleen

Experts: hired lackeys - & moon made of cream cheese.

draust — Thu, 08 May 2008 09:41:24 +0000

It is a bit of a tough gig being an “expert” these days.

Not so much in what I do, of course. It is not as if there is all that much controversy – or interest - surrounding the Delta-like cells of the crayfish hepato-pancreas, or whatever it is people like me spend their time fiddling about with. Even if I were to put on my work website that I was a “world-renowned expert in cell physiology”, or whatever, it would raise few hackles, although the thirty people worldwide that actually read my papers would have a quiet snigger at my delusions of grandeur.

The wider world, I predict, would be unconcerned.

- until I start commenting about alternative medicine, or CoQ10, or homeopathy, at which point I will get accused by people I have never met of being in the pay of “Big Pharma”, or, as our nearly four yr old, Junior Aust, says, ”Evil Farmer”.

For the record, the biggest “payday” I have ever had from Big Pharma was a free lunch (once) in AstraZeneca’s nice staff cafeteria at Alderley Park. Other than that, nothing - not even a small consultancy fee. *sigh*

But it is quite different for experts in things like medicine… the stakes are high, and some people nowadays seem to think that all “Experts” are corrupt tools of Shady Corporate Interests, or of “the Medical Establishment”.

So what really makes “an expert”?

It is a truism of science that the more you know about something, the more “expert” you are. For this reason, the average person who reviews scientific papers for a serious scientific journal – an “expert reviewer” - will be someone who has a degree, a PhD, several years’ worth of postdoctoral research experience, and preferably does, has done, and often supervises other people doing, work very similar to the stuff they are reviewing.

The point is that you have to know the subject, and the type of work, and how it is done, inside-out to see the errors, if any. And also to see where the authors may have finessed things slightly by comparing things that are not strictly comparable, and so on.

The result is “expert peer review” - a fully-informed expert opinion on a particular piece of research, or on the latest meta-analysis.

You know you are an expert in this sense because other experts decide that you are. For instance, proper high-end science journals (and this does not mean all the thousands of journals you can find listed on Pubmed) are picky about their expert reviewers, as it is on these peoples’ rigor that a journal’s standards depend. It is for this reason that scientists sometimes list, on their professional CVs, the journals they review work for.

Conversely, I think we can say it a safe bet that the venerable Journal of Physiology is not going to be asking Sir Cliff Richard to review the next paper about whether antioxidants help older athletes get less post-exercise muscle pain.

Sir Cliff is not, whatever the food supplement industry appear to think, an expert.

However, not all public statements about research, especially medical research, or its interpretation, come from the experts.

Indeed, on many issues expert opinion is vastly outweighed by comments from what one might politely call “advocacy groups”. These include, but are not limited to, patient groups.

This presents interesting problems. One in particular is: can one trust the messages emerging from such groups?

And if we say no, are we saying that only real experts should be allowed to have a view?

Context is critical (again)

Well, let’s stay with the profile of an expert, and their ability to interpret the evidence. This ability to interpret research is a question of degrees of relevant knowledge. But it also depends critically on being able to put the research in the proper context – that is, having the background to know things relevant to the research that are not explicitly written down in the paper.

This is something scientists, and doctors, are taught in varying ways. But they are taught it. For instance, take a PhD viva (the oral examination that follows the submission of a PhD Thesis and constitutes – hopefully - the last stage of getting a doctorate).

In the viva, you do not get asked about just the experiments in your PhD thesis.

You also get asked about other experiments in the literature that bear on whatever question or questions you are seeking to answer. You get asked about the broader background area, and where your work fits it. You get asked about the key theories in the area that underpin and lead up to your work, and how strongly the experimental evidence supports them. And you get asked why Dr Y’s experiment got a different answer to yours, particularly in terms of analyzing the differences between your experimental design and Dr Y’s. Was the answer different because the patient blood samples in your experiments came from women aged 16-20 who volunteered for a specific study, while Dr Y’s were from women aged 18-30 who had been sampled for a study into something else? What are the potential ways that that could make your study populations different and thereby explain the different answers you got? Is there other evidence to support any of these potential explanations?

…and so on, and so on.

And apart from being taught it, this “contextual knowledge” is also acquired bit-by-bit over years in research, or medicine. It forms one useful kind of accumulated experience.

The reason I am harping on about this is that many advocacy groups include, or even employ, people who have read a lot of medical and scientific studies, and sometimes consider themselves experts. But their expertise often lacks a critical dimension: they commonly do not understand all the background. And I mean “background” here in a very broad way; I am including not only “the broader science in this field” and “earlier studies like this”, but also “the underlying assumptions of the work”, “the ways in which studies like this can be biased” and – very critically - “the ways in which statistics and statistical testing work in relation to this kind of experiment”

From the above, you can see that there are a lot of different levels of understanding that one can have in relation to a scientific topic.

Which is NOT to say that you cannot have an opinion unless you are a full-on “academic ninja” expert. I mean rather that you should try to recognize the limits of your knowledge, and understand that other people will inevitably know more (or less) about it than you.

[This goes, incidentally, for doctors and scientists, obviously including me. I know more than some people, and less than others, and this is subject-dependent. I know, for instance, more about acid-base balance than most physiologists. But I know less than a hospital doctor, who in turn knows less than a real “acid-base ninja”, like an anaesthetist or intensive care specialist]

Of course, in the public arena, many or even most people seem to not be too good at this “grading” of their level of knowledge.

To take an example…

As an illustration, take the controversy over home birth. Dr Crippen over at NHS Blog Doctor is currently taking a shot at some midwives in Kent (these midwives are independent of the NHS and charge for their services). They ran a home delivery for a mother with a long string of “risk factors” that would have lead any obstetrician, and probably most NHS midwives, to conclude that the mother would have to be bonkers to want a home birth. Dr Crippen is angry because the independent midwives seem to be unaware of the dangers, continually referring to the caution of the mainstream doctors and midwives as “shroud waving”.

The case described by Dr C is pretty extreme, judging by what my medical advisor (Mrs Dr Aust) tells me. But home birth is a contentious issue all around.

And in homebirth, a battle is being fought over precisely what the statistics tell you about whether home birth is more dangerous than giving birth in hospital, and by how much.

The doctors I have asked are unanimous; home birth is more risky for both mother and baby, they say, mainly for the obvious reason that if something does go seriously pear-shaped, you want to be in a hospital.

This extra risk, the doctors concede, may be slight and acceptable for ultra-low-risk normal births under ideal conditions, that is, where the overall (absolute) risk of something going pear-shaped is very small. However, the more “non low-risk” the pregnancy (i.e. the more factors there are suggesting an increased chance of complications) the relatively riskier home birth becomes. And if conditions are not “ideal” (for instance less experienced midwife, long drive from nearest maternity hospital in case of pear-shaped-ness, etc), then that all adds to the risk that is being taken.

For what it’s worth, among all the female doctors with children Mrs Dr Aust and I know, we have never met a single one, in any specialty, who opted for a home delivery.

But the home birth groups dispute the above view, and also the idea that the doctors, and even the hospital midwives, are speaking from expertise rather than ”medical paternalism”. The home-birthers feel they should have the right to choose home birth. They also point to published analyses that say that for low-risk deliveries, home birth is no more dangerous than hospital birth. Typically, a fierce and detailed argument then ensues about exact which figures do (or don’t) mean what different people say they mean. If you want to see this in action, try the discussion thread following Dr Crippen’s post

So - who to believe?

I won’t give my own opinion, for the following reason: I am not an expert in the relevant areas.

However, I think I can say who I would regard as “an expert” on the question.

It is, as ever, a question of “degrees of expert knowledge”. Who are the people most likely to know all the studies, all the background, all the factors influencing the trustworthiness or otherwise of individual studies, and all the hidden catches in comparing different patient groups and studies?

Well, for me, it’s no contest - the answer is that I would put Professors of Obstetrics & Gynaecology (O&G), or experienced hospital O&G consultants, at the top of the expert scale for this particular issue, and Joe and Joanna Public at the bottom.

The advocacy group people, even if they have scientific or medical backgrounds, would rate well below the Professors and consultants, at least for me. This is both because they have a clear agenda going in, and also because they mostly lack the full background necessary to interpret the evidence properly. I would thus be suspicious about whether any message they were putting out was strictly accurate. And my personal bete noire, journalists with no training in science or statistics, would rate pretty damn low on the expert scale, though we hear a lot from them on this issue (for a particularly misleading recent article see last week’s Guardian here).

Personally I think there is a lot of danger in folk who cannot see that there are people who know more than them (or even concede that such people probably exist) when looking at this and other issues to do with interpreting research. To repeat it again, you have to be aware of how much you know, and how much you don’t, if that doesn’t sound too Donald Rumsfeld.

Where to find the good stuff…

Plus, once you have established you don’t know enough, you also have to know where to get the information that you are missing, and from whom.

To give one example: let’s take a family doctor who has heard something about all the homebirth discussion, but hasn’t read all the recent studies, and is confronted by someone who insists that they have read that the statistics say home births are as safe as hospital births.

The doctor knows he or she needs reliable information. Luckily they know that, say, a Cochrane review written by an O&G Professor would be the place to go for the goods. And they would almost certainly rate this higher in their “evidence hierarchy” than a review in a lesser scientific journal penned by the chief advisor of a charity that promotes home births. They would certainly rate published journals studies higher than figures quoted on websites that have never been through peer review.

That is not all there is to it, of course. Our hypothetical doctor might read the two reviews side-by-side, comparing what they said about individual studies, and thus improving their understanding of how research in the area is interpreted.

Where to put your trust?

Now, this is fine if you have relevant expertise and know what to do, and where to go for information.

But: how does this discussion about the nature of experts help Joe Public when he or she is confronted by the need to make a decision? Or in the case of prospective parents and the home birth issue specifically, who should they get their messages from?

As I see it this reduces to - who can you trust to have an expert view on this, and communicate it to you without a hidden agenda, whether ideological or financial?

My answer for childbirth, having been through it as a prospective parent, would be the obstetricians and hospital midwives. Because it is their business to know the facts, and also their professional responsibility to try and get the best outcome for you and your unborn child.

In contrast, I would not expect to get anything like a dispassionate view from a homebirth advocacy group, even when they say they are “quoting the studies”.

The trouble is that there is so much propaganda about, much of it masquerading as journalism - see e.g. the Guardian article linked to above - that it must be incredibly difficult for people to know who to believe.

The danger is that they will make the decision first, based on irrational fears or on preconceptions that may be mistaken. And they will then get this uninformed decision reinforced because there will be some information, somewhere, that agrees with and applauds their choice, even if their choice is objectively ill-advised.

To me this parallels other “reality meets preconceptions” problems in health like the MMR vaccine saga. Once people have bought into the idea that “the doctors / experts / government aren’t telling me everything” - or that the doctors are pushing a particular agenda , “medicalising birth” or “pushing drugs and vaccines for Big Pharma” - then the patients / parents are cast adrift amid a sea of misinformation. They – or perhaps I should say we, since I am a patient too - are at the mercy of lots of advocacy agendas, all too commonly armed with prejudice, misguided certainty, and masses of misused stats.

Experts under fire

So just how did we end up doing this to professionals and experts? Have we, as a society, decided that their opinions are just another optional paid-for add-on?

Experts and professionals certainly are sometimes mistaken. They sometimes do not explain enough. They certainly do not get enough help from professional explainers explaining science and medicine. They are, rather too often for my taste, hung out to dry by Governments who pick them up and dump them as a matter of political expediency. And finally, experts are at times guilty of digging their own holes to fall into – e.g. by doctors trousering large consultancy fees from pharmaceutical companies.

But is that enough to dump expert views entirely? Do we really think all mainstream experts are incompetent and arrogant? Or that self-interest is their only motivation?

Personally I am happy to let the pilots fly me, the anaesthetist anaesthetise me, and the lawyer tell me what is, or isn’t, legal. And I am also aware that you can’t believe everything you read - though on the whole I believe it more if the writer is a real expert, and is not trying to sell me something.

But it sometimes seems, these days, that I am in a minority on both counts.

It is a worry.

PS Sorry for the long and boringly unfunny ramble. Hopefully there will be more satirical snarking next time.

Quote of the day: “I can live with doubt and uncertainty and not knowing. I have approximate answers and possible beliefs and different degrees of certainty about different things… It doesn’t frighten me.” - Richard Feynman

New Celebrity endorsement for antioxidants

draust — Mon, 21 Apr 2008 20:45:34 +0000

The anti-ageing effects of antioxidant vitamin supplements were yesterday extolled by legendary film star and bon viveur, Count Dracula.

The Romanian aristocrat turned actor and personality explained that without his tailored regime of antioxidants he would never be able to sustain his punishing round-the-clock lifestyle. Count Dracula joins other celebrities, like Sir Cliff Richard, Gloria Hunniford, actress Jenny Seagrove and Carole Caplin, who have spoken out to defend supplements after recent medical studies suggested that antioxidant supplements did not benefit those taking them, and might even be harmful.

“Of course that’s complete rubbish”, says the astoundingly youthful-looking Count emphatically. “I take vitamins A, B, C D, and E every day, as well as Beta-Carotene and N-acetylcysteine by the bottle-load, and I absolutely swear by them all”.

The one antioxidant Dracula doesn’t take is Selenium. “It makes your breath smell of garlic“ he says. “I’ve simply never been able to abide garlic - dreadful stuff.”

Dracula’s supplement regime certainly seems to be working – he hardly looks a day over forty, though persistent rumours place his birthday somewhere in the 15^h century. The star is understandably coy about his exact age, admitting only that he has “seen a few centuries come and go”.

Dracula looks especially well for a man who admits that he had been laid up only a couple of days before with a bad stomach. “I must have eaten someone that disagreed with me” he quips. He thinks perhaps the meal that laid him low probably contained too many chemical food additives.

“I do try to stay strictly organic”, he says ”but when you’re on the move so much it’s hard to find really good food, and you never really know where it’s come from. Often it says it’s organic, or vegetarian, but how can you be sure?”

Dracula also has a special dietary problem – his unusual diet is rich in iron and protein, but missing the fruit and vegetables that normally supply phytochemical (plant-derived) antioxidants.

That, he says, is where the antioxidant supplements help.

“Yes, it’s partly a detox thing” he says. “As a Haemo-tarian, I take in really incredible amounts of iron. It gives me bags of energy, of course, but I do worry about getting iron_overload. Of course, all that iron means my system is under a really tremendous amount of oxidative stress, and that’s where the antioxidants come in. Without the vitamin C and vitamin E, and the N-acetyl-cysteine, I think I would be in real trouble”

He is scornful of the recent science suggesting antioxidants don’t help people stay healthy.

“How can they just mix all those different trials in together and get a sensible answer? People are individuals. I don’t know anyone else who eats the sort of diet I do, so how can these scientists possibly say the supplements aren’t going to help me? And of course these so-called scientists have to say that so that the drug companies can make money, don’t they? They don’t want people getting healthy on their own without their pills Personally I’ve never taken so much as an aspirin.”

The Transylvanian-born star certainly seems ultra-healthy, not to mention in splendid form – “call me Vlad” he says, with that famous toothy grin. Our interview takes place at 4 am, but he looks as if he is just getting ready to go out for a night on the town. He does admit to being “an unapologetic 100% night person”.

Given his nocturnal hours and hectic schedule, simply finding the time for a sit-down meal can be a problem.

“Being awake at odd hours, as I am, simply plays havoc with your normal eating habits” he laments. “You can’t always just grab a quick snack on the run, especially if it’s hard to catch. I try to eat regularly and not snack in between, but sometimes I do get the most terrible cravings.”

When he does succumb to the need for a snack, Dracula know what he likes.

“I simply adore traditional black_pudding as a quick bite” he confides “but I can’t eat it too often. I worry about all the nitrate preservatives they put in it, you know”.

Enigma, Bletchley, and ordinary heroes

draust — Fri, 11 Apr 2008 22:46:35 +0000

In early April BBC Radio 4 carried a radio programme - part of the series “The Reunion” - that anyone who uses computers or calculators, or who has any interest in codes and ciphers, really should have listened to. (Unfortunately it is no longer up on the BBC’s Listen Again site - if it is lurking somewhere else on the web, esp. as an MP3, I would be grateful for info on where).

The programme re-united several people who had taken part, in their early 20s, in perhaps the greatest ever piece of “Signals Intelligence” work, and certainly the greatest feat of sustained codebreaking, ever. This was the top secret work at Bletchley_Park, outside London, during WW2. In total secrecy, a core of mathematicians, boffins, military codebreakers and bright young Oxbridge types, and a much larger staff of mostly female assistants, cracked the codes the Germans used for all top secret communications. These codes were mostly based on the fearsome Enigma cipher machine, which the Germans regarded as uncrackable. It remains questionable whether the Allies would have been able to defeat Nazi Germany without the information derived from the Enigma decrypts, and the work is widely viewed as having shortened the war by two to four years. The computation machines built to attack the Enigma ciphers, including the Colossus, were among the key forerunners of modern computers.

With typically British-ness, after the war the British government mandated the “sanitizing” of anything at BP that would tell people what had gone on there, right down to dismantling all the equipment down to individual components. The site became a training college for telephone engineers. As all the people who had worked at Bletchley had signed the Official Secrets Act, it took nearly 30 years – until 1974 – for the first hints of the Bletchley codebreaking story to emerge, and even longer until accurate accounts appeared. Luckily many of the buildings were saved from the bulldozers (just) in 1992 and are now preserved as a museum. The piece de resistance is a reconstructed, and fully working, Colossus computer.

Bletchley Park and its work is now more widely known through fictionalized portrayals, such as Robert Harris’ novel Enigma and the 2001 film derived from it. The book is a good starting point for the Bletchley story. The list_of_people that worked at, or for, the real Bletchley Park includes a remarkable gemisch of British mathematicians, academics, (not just scientists), a couple of chess champions, and even a future Chancellor of the Exchequer.

The computing machines built at Bletchley used pre-transistor valve technology. When I visited the Bletchley Museum a decade or so back I remember being struck by this since my father, who I went with, was a teenage radio geek in his time and a whizz with valves (he subsequently studied physics). One of my abiding childhood memories of my dad is of him with his head buried in some old radio, or TV set, or other electronic thingummy, which he would be trying to mend. If not there he would be under the car, or washing machine, trying to fix that.

Anyway, walking round Bletchley I was struck by how people not that many years older than my father was then, and with the same sort of skills (radio, and electromechanical tinkering, and physics know-how) had built the machines from scratch. Although the electrical engineers like Tommy_Flowers never got quite the recognition of the mathematicians and codebreakers like Alan Turing, they were indispensable too. Perhaps this is a reminder that while in science you need geniuses and visionaries, you also need people who can turn the visionary ideas into real experiments, or techniques, or machines.

When my dad and I visited BP in the 90s some of the volunteer helpers were people who had actually worked there during the war, while electronics enthusiasts of similar vintage were busy reconstructing the Colossus. The word I would use to describe these people, then in at least their mid 70s and now well into their 80s, is “formidable”. Or even better, “indomitable”. I had the same feeling again listening to the Radio 4 show. Anyway, a tremendous piece of living history, and a fitting testament to peoples’ ingenuity and ability to meet challenges.

Brain Gym loses its trousers (figuratively)

draust — Tue, 08 Apr 2008 00:15:53 +0000

The Bad Science firmament has a new star.

Step forward… Charlie Brooker

Today in the Guardian Charlie Brooker gave the laughable Brain Gym one of the funniest and most comprehensive rhetorical flayings I have ever read. It brightened up a dull Monday.

It is also, I confidently predict, the only time Charlie Brooker’s column is ever likely to mention the British Neuroscience Association, or the Physiological Society.

I should say that Brain Gym, or more accurately Brain Gym^® is (in case there is anyone left who hasn’t heard of it) a series of “ fun exercises” for schoolchildren to do in class. It has been widely used in UK schools over the last few years.

Well, what’s wrong with that, I hear you ask? Anyone who ever revised for a load of exams will probably remember the advice to get up and walk round the room, or stretch, every 30 minutes or so. So why not little exercises for the kids?

Well, there are a couple of answers.

The first is that Brain Gym^® comes equipped with a ludicrous set of pseudo-babble explanations. And posts from anonymous teachers back when BadScience discussed Brain Gym suggested that they were made, on pain of dressing down and even disciplinary measures from the Head, to buy into these explanations in their Brain Gym^® training sessions.

So the teachers are told by the trainer, and may even pass on to the kids, idiotic stuff like:

“Rubbing these [Positive Points] above each eye with the fingertips of each hand… brings blood flow to the frontal bits of your brain where rational thought occurs.”

The charity Sense About Science, in the person of our own Frank the science punk, has now got some neuroscientists together to do a comprehensive debunking job on all this. For instance, referring to the explanation just give, they quote Prof David Attwell FRS:

“Rational thought does not just occur in the frontal lobes, and there is no evidence that touching these points can alter blood flow within the brain.”

…More of this here, where you can see all of the Brain Gym^® explanations and a list of simple (but scientific) reasons why they are nonsense.

Yep, the Brain Gym^® explanations are what noted educationalist the late Ted Wragg used to called, to put it in technical language, “World Class Bollocks”.

Basically, everything that comes with Brain Gym^®is pseudo-babble. Even the name of Brain Gym^®’s UK supplier carries the Pseudo-babble taint – step forward UK Educational Kinesiology (sic).

And would you believe it, the “UK Educational Kinesiology Trust”, actually admits on the very first page of their website that Brain Gym^®’s explanations are made up:

“The UK Educational Kinesiology Trust makes no claims to understand the neuroscience of Brain Gym^®. The author has advised that the simple explanations in the Brain Gym Teachers Edition about how the movements work are hypothetical and based on advice from a neurobiologist at the time the books were written.”

Hmm… “hypothetical” …“based on advice from a neurobiologist”.

Allow me to translate:

The author, when he was dreaming up all this out in Southern California, took one neurobiologist he vaguely knew out to lunch. After a good meal and a few glasses of wine, he asked: ”Can you think of any sort of hypothetical mechanism that anyone has ever suggested for how any of this stuff might work? But something that wouldn’t sounds too science-y? Sort of like any theories there are of how massage or stuff like that might work? Anything?”

Having half-remembered whatever vague hum-ing and hah-ing the anonymous neurobiologist came up with, the author then gave it a sort of New Age-y coating and… bingo:

A Global Phenomenon was born.

Which brings us to the second thing I dislike about Brain Gym^®. It is A Commercial Product, and is sold to schools. The schools pay to have an “authorized Brain Gym^® Trainer” come in and teach the teachers – who have almost certainly been ordered to give up their time to be there – to “use” Brain Gym^®. The whole package costs.

As the Americans like to say, “Your tax money at work”

So to sum up:

What can we say for, and against, Brain Gym^®?

Sort of for: the children do little exercises to break the routine of class, which might – depending on the teacher’s command of the class – be sort of helpful

Against: the explanations teachers are sold are complete and utter bollocks. Anti-science. Nonsensical explanations with no basis in reality.

Also against: someone is making money off all this. And the fact that it is being paid for will almost certainly ensure that its use is being “mandated”, and pushed. And the money that has paid for this is yours, the public’s, and could have paid for more books, or teachers, or sports equipment.

Also against: coming back to the explanations, we are mingling reality and unreality, and basically giving children the steer that there is no meaningful difference between one and the other. As Charlie Brooker puts it:

“fantasy and reality [are] both …great in isolation, but, like chalk and cheese or church and state, are best kept separate.”

And if we start them with nonsense young, why are we surprised when people grow up unable to distinguish sense and nonsense?

On which topic, the last word should go to Brooker, who puts it much better than me:

“If we mistrust the real world so much that we’re prepared to fill the next generation’s heads with a load of gibbering crap about “brain buttons”, why stop there? Why not spice up maths by telling kids the number five was born in Greece and invented biscuits? Replace history lessons with screenings of the Star Wars trilogy? Teach them how to whistle in French? Let’s just issue the kids with blinkers.

Because we, the adults, don’t just gleefully pull the wool over our own eyes - we knit permanent blindfolds. We’ve decided we hate facts. Hate, hate, hate them. Everywhere you look, we’re down on our knees, gleefully lapping up neckful after neckful of steaming, cloddish bullshit in all its forms. From crackpot conspiracy theories to fairytale nutritional advice, from alternative medicine to energy yawns - we just can’t get enough of that musky, mudlike taste. Brain Gym is just one small tile in an immense and frightening mosaic of fantasy.”

Tell it like it is, brother. And roll on the next column.

An imperfect (Q) ten

draust — Wed, 19 Mar 2008 22:02:20 +0000

This has been another of those fortnights of “deja-vu all over again” (in baseball legend Yogi_Berra’s famous phrase), as the newspapers have been full of plugs for “Miracle Supplement” Coenzyme_Q10.

Boots are having a big marketing push for their latest formulation of CoQ10, claiming that it will give you lots of energy, and even offering “your money back if not satisfied” (Boots apparently have confidence in the power of wishful thinking and the placebo effect).

Boots’ press release and promo campaign seems to have generated the usual crop of dim features in the “Health and Beauty” or “Lifestyle” sections of several of the UK national papers. Most of these features, as both Ben Goldacre and David Colquhoun have deconstructed, revolve about deliberate overuse of that misunderstood word, and favourite Alt Health trope, “energy”.

[The mention of “Energy” is, of course, a surefire stand-by for a good dose of health page waffle. The very word drips waffle, and probably scores you a Canard or two on the Quackometer. Wikipedia lists a bunch of usages for “energy”. It is no accident that half of them relate to favourite Alt Health Woo-themes like “spirituality”.]

If you are especially unlucky, your newspaper may have leavened the energy-waffle with what we call a “Media doc filler”, or “MDF” for short. For those that are unfamiliar with this genre of newspaper space-filling, an MDF often accompanies a feature on a new supplement , or heavily marketed medicine, and goes something like this:

——————————————————————————————–

NanoNutri LipoBalls – A Doctor Writes:

“As a national newspaper doctor I am frequently asked by the nice chaps and chap-ettes on the “Nutrition and Health“ pages: “can we have a quick 300 words to pad out this press release - sorry, story - about some expensive supplement?”

My answer is always “Only if it will help tackle my low financial energy levels, sunshine”. And aren’t low energy levels something we all increasingly suffer from in today’s non-stop energy-sapping 24-hr world?

It is amazing these days how often my patients seem to wish they had more energy.

I don’t know how many times I have heard a patient say to me “I feel worn out, doctor”. To which I usually respond: “That sounds very much like what we doctors call an “Energy Deficiency” - fifty pounds, thank you, pay the receptionist on your way out. Next!”

Twenty thousand or so years ago, a quick sabre-toothed tiger hunt would have left primitive man with a huge appetite, but after a haunch of roast mammoth and 12 hrs solid sleep he would have been ready for anything. However, nowadays we work so much we hardly have time to eat, or to sleep more than five hrs a night – and when we do eat it’s more likely to be a hurried prawn sandwich than mammoth supreme.

Faced with that, who couldn’t do with a bit of a pick-me-up? And new NanoNutri LipoBalls® are formulated with EnergyNano’s patented Fast Liposome Intra-Mitochondrial Formula Liquid-energy AntioxidantMax technology, or “FLIM-FLAM” for short, to get extra-fast to the parts other Energy supplements cannot reach.

So how were the results? Well, within a few days of first encountering NanoNutri LipoBalls®, things were certainly looking up. Having banked a pleasingly large cheque, I found that my energy levels had been dramatically improved. A spring had returned to my step, a twinkle to my eye, and a satisfying bulge to my wallet.

(Is that enough?)

A Doctor”

——————————————————————————-

Now, while I may have been mysteriously “channeling” Private Eye’s fictional Dr Utterfraud here, I am not exaggerating by all that much. If you don’t believe me, read this.

Where does all this hype come from? Well, you can find plenty about CoQ10 and what it does on Wikipedia, but a brief summary would be that it is a chemical substance that is important for how your mitochondria work. Mitochondria are your cells’ “powerhouses”, converting chemical energy (substrates, a posh biochemical word for “fuel substances”) into carbon dioxide and water, with the concomitant production of the cell’s “energy currency” molecule ATP.

Here you see the beauty of the CoQ10 sales spin. The description above mentions energy – here in its scientific sense. So voila – mention that CoQ10 helps produce “energy” and it is an instant sell. Everyone would like to have more “energy” (in its non-scientific sense of “get up and go”, the sort that parents wonder at in their small children while bemoaning that they don’t have themselves).

All you have to do is plant in peoples’ minds the two ideas that:

CoQ10 has something to do with energy (true)

Energy (scientific sense) = energy (vernacular sense) (false)

and the result is Ker-chinggg – cash registers jingle.

Now, an interesting aspect of the current “Q10 buzz” is that CoQ10 was discovered fifty years ago. It is not new. And it has been around, as a supplement, for at least 15 and probably closer to 25 years. Very “Not new”, in fact. And it has been tried as a therapy or “performance enhancer” in all sorts of studies - on various diseases, from receding gums to cardiovascular problems to Alzheimer’s, on exercise tolerance and performance etc etc.

So what were the results of these studies? Did they show Q10 was the miracle supplement the current crop of stories seem to be claiming?

The answer is “No”. The studies are inconsistent, with the usual problem of small sample size and lack of “blinding”. But the scientific / medical consensus, which you can find a good summary of here, is that there is basically no indication to take CoQ10 even if you are ill, let alone if you are well.

This is actually an object lesson in the different kinds of evidence that one can have for therapies, including pills, and why some types of evidence are more reliable than others. The “hierarcy” of evidence often used nowadays to decide if treatments can be viewed as actually working (and hence can be recommended for widespread adoption as part of medicine), is shown below. This hierarchy allots higher “levels” (essentially “greater reliability”) of evidence to randomized controlled trials (RCTs), and the highest level of all to “Systematic review (with homogeneity) of RCTs”. This last means when you look systematically at all the RCTs together, if you find that the treatment is consistently coming out as effective then it is a very good bet that it really works.

Various other kinds of studies are less convincing than this - a single, but good trial scores grade 1b, a not-so-well-done RCT scores grade 2b.

Figure: Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001)

(via Dr Kimball Attwood’s wonderful post on evidence based medicine and Alternative medicine here)

Level	Therapy/Prevention, Aetiology/Harm
1a	Systematic Review (with homogeneity*) of RCTs
1b	Individual RCT (with narrow Confidence Interval‡)
1c	All or none§
2a	SR (with homogeneity*) of cohort studies
2b	Individual cohort study (including low quality RCT; e.g., <80% follow-up)
2c	“Outcomes” Research; Ecological studies
3a	SR (with homogeneity*) of case-control studies
3b	Individual Case-Control Study
4	Case-series (and poor quality cohort and case-control studies§§)
5	Expert opinion without explicit critical appraisal, or based on physiology, bench research or “first principles”

Studies which have designs OTHER than a randomized controlled trial score lower. In particular, studies whose design means they tend to be relatively UNreliable (often because they are contaminated by ”expectancy_effects”, by selection_bias relating to the participants, or by regression_toward_the_mean) are down in grade 4. Here the way the trials is done is often “give people the pill, with no control group and no placebo, and then ask if they think taking it made them feel better”.

The similarity between this last one and a “money back guarantee” if you didn’t think Q10 supplements gave you more energy is not a coincidence.

Finally, the idea that “because this works in a dish it will work in people”, much used to plug Alternative medicines, is down at grade 5, as is another familiar one, “this works because this or that expert guru says it does, regardless of the lack of any critical appraisal of the evidence to back it up”.

The talking-up of CoQ10 in leaflets, and on websites, and now in the papers, is mostly a fancy example of the “because it works in a dish” (level 5) argument down at the bottom of the pile. And most of the existing CoQ10 trials in humans, which some of the stories refer to en passant, are down at grade 4. Reviews of the trial evidence on CoQ10 tend to be (at best) in grade 3a, since the trials usually lack “homogeneity” (i.e. the results are inconsistent).

The upshot is that Q10 would not get licenced for use as a medicine in any common condition, because the evidence that it produces benefits simply is not good enough. The only exceptions, thus far, are very rare, mostly genetic, and specifically mitochondrial diseases.

Repeat: For all the other stuff, the evidence simply is not there.

Incidentally, this is true even if you take something where there seems to be a really appealingly plausible scientific rationale for using CoQ10 (grade 5). The best-known example is probably in people taking statins. Your cells make their own CoQ10 – another reason why the need for supplements is very dubious – and the biosynthetic pathway leading to CoQ10 is “shared” (part of it) with cholesterol biosynthesis. Hence the common website claim that if you are taking cholesterol-lowering statins (which partially inhibit a key enzyme in the pathway) then you “need” to supplement your CoQ10.

Sounds plausible. However, it turns out that the trial evidence is not running in favour of CoQ10 supplementation even when people are taking statins, and even in the subgroup of people on statins who have symptoms suggestive of statin side effects (Coracle has written about this at length). So if CoQ10 were to be marketed as a medicine for this statin setting there would not be nearly enough evidence to approve it. This points up - again - the difference between the efficacy standards required for drugs (there are some) and supplements (there aren’t any).

Of course, if there isn’t convincing evidence that CoQ10 makes a difference even in a situation where using it might seem biochemically highly “plausible”, you can bet your mortgage there is bugger all reason for normal people to take it on the off chance that it will do something. Apart from making the supplement peddlers considerably richer,

But…. To keep repeating the obvious, you don’t need any evidence to market a supplement. You only need to show that it doesn’t seem to be toxic.

Plus ca change, plus c’est la meme chose

Getting back to “déjà vu all over again”, the CoQ10 thing prompted me to have a dig through my own files. Back in the mid 1990s – about 1995 or 96, I think - I remember seeing a big display of CoQ10 pills in Boots. (Yes, amazingly they already sold them back then). As a ”recovering Biochemist”, this piqued my interest, so a year or two later I started setting medical student dissertation topics (i.e. reviews of the scientific literature) about supplements and alternative remedies.

Which leads me to this: lurking in my files is a dissertation a first year medical student wrote for me back in 1999 (sic) on:

“Coenzyme Q10: snake oil or medicine?”

[The student would have graduated in 2003 and is now, I guess, a junior doctor]

A couple of sample quotations:

”While some adverts for CoQ10 make use of anecdotal evidence from individuals testifying to “the miracle of Q10”, others make weightier-sounding allusions to scientific studies. But to what extent are claims made by the supplement industry upheld by scientific studies?”

A question Dr Thomas Stuttaford, Boots, and various health page journalists appear to have forgotten how to formulate. The answer, as we have already seen above, is “Not very much, if at all”.

Another bit from the student’s work discussing the “lifestyle-enhancing” claims for Q10:

”…What constitutes “normal” levels [of CoQ10] is of course open to debate. While no frank CoQ10 deficiency has yet been described, Folkers claims that suboptimal levels of CoQ10 are universal. There is, however, little current evidence to suggest that CoQ10 supplementation benefits the healthy individual.

Despite this, many people do take CoQ10, seemingly unconcerned about the lack of scientific evidence to support the anti-ageing, energy-boosting, flab-fighting, brain-stimulating and sex-life enhancing claims the adverts boast.

Adverts on the Internet may allude to scientific studies but generally fail to provide references and information is sometimes presented in a misleading way. They generally use a didactic tone and sometimes warp information to [persuade people] to buy their product, as demonstrated by the following advert:

”The body’s levels of CoQ10 decline with age; therefore it is necessary to supplement the diet. Food does not contain significant amounts of CoQ10 and the body des not produce enough CoQ10 on its own, so supplementation is imperative in order to have adequate amounts of it” (Emphasis added).

[Furthermore], findings of low levels of CoQ10 in disease states do not necessarily imply that low levels will lead to these diseases, as some adverts claim.

All [this] renders consumers vulnerable, all the more worrying since direct-to-consumer advertising of [nutriceutical] products is now big business. …”

Hmmm. Now, it is fair to say this was a bright student, even by the normal bright standards of first year medics. But… armed with essentially A level-plus-a-bit scientific knowledge, a first-rate brain, and a questioning mindset, s/he could see through the claims of the supplement peddlers. So one might expect that Boots’ “panel of experts”, Ann Walker PhD, and even Dr Stuttaford ought to be able to take a slightly more balanced view.

…If they wanted to.

And there’s the catch.

If they wanted to.

Boots, remember, are trying to sell you something. So is Ann Walker. Why should a seller tell the truth if spin sells better? And Dr Stuttaford is making a living cranking out re-worded press release bumpf.

Plus - there is nothing to stop them. Provided they avoid making directly and demonstrably false claims - as opposed to writing ambiguous things that will merely encourage readers to draw obvious but erroneous conclusions – they can say what they like.

As ever, caveat emptor. And that means you.

What gets children into science? The stuff we’re cutting… like Jodrell Bank

draust — Sat, 08 Mar 2008 23:30:16 +0000

Dr Aust is, in case you hadn’t guessed by now, A Grumpy Old Fart.

Well, a Grumpy Middle-aged Fart, to be exact.

(I have searched high and low for an age definition of “middle aged” that WON’T include me, but I have finally had to admit defeat.)

So I am middle aged.

BUT: once I was young. Honest.

One of the things middle-aged people with Blogs do a fair bit of is wondering how they got to where they have ended up, life and career-wise.

So… how did I get interested in science?

Well, I did have a relative in the family generation above me who was a scientist, but I never had much idea what he did, except that it took place somewhere called a “laboratory”. Said relative was once persuaded to come to my school and show us kids a laser, and a hologram, which was quite neat. And he once tried to teach me physics, which ended in tears after about an hour. I have never been much good at physics.

But I’m pretty sure that wasn’t why I got interested.

No, personally I blame, inter alia, Gerald_Durrell’s books about animals, John F Kennedy and the manned space programme, Gene “Star Trek” Roddenberry, Look_and_Learn magazine and the sadly-no-longer-extant London_Planetarium.

Because: how could any small boy NOT be interested in animals, and fossils, and dinosaurs, and rocks, and volcanoes, and moon rockets, and space travel, and stars?

The path from there to my corner of cell biology and physiology is a bit tortuous. But I still think that the natural world, and all the remarkable things in it, on it, under it and visible from it, are where science starts to exert a fascination on the young. Junior Aust, now approaching four, is being shown how to plant seeds, and told (as much as possible) how the cartoons she likes to watch on Youtube arrive on the screen down the telephone wires, and where real tigers live (she is fond of tigers).

But what if Pop Idol is more interesting?

Common to most scientists I know, when feeling pessimistic, is the view that if we can’t get children interested in the natural world, then we will not be able to get them interested in science later on. With all kinds of (bad) consequences.

So any thing, or place, that tries to get children interested is A Good Thing, in my book.

Oddly, it seems the UK Government does not agree, despite all the tedious oily “Of Course”-ing about how vitally important science is to the nation’s future prosperity.

Thirty odd miles down the road from Chez Dr Aust is the Jodrell_Bank Observatory. This is a major site for UK astrophysics research, and specifically for radio astronomy. The Lovell_telescope, which is 50 yrs old, is one of those objects/ images that almost personify scientific research, testifying to the slightly bonkers constructional genius of some scientists and their endearingly obsessed determination to find things out. It must be one of the most recognisable objects associated with UK science. I first saw it when I was about 30, but I had seen a picture of it in a book when I was no more than 5 years old. And it is undeniably impressive – I’ve seen the Jodrell telescope, and Dolly_the_sheep, close-up, and the telescope wins hands down.

But Jodrell Bank is more than that. It also has a science visitors’ centre. And a Planetarium (sadly currently shut for repairs). And a 30+ acre garden and arboretum you can wander round with over 3000 plant species. And it is reasonably cheap to get into, even if you take an entire family.

So to summarize: cheek by jowl with a place where real scientists do real science, a national centre yet, you can take the children to a stardome simulation, or wander the garden with them and look at the trees and plants. You, and they, can stand right underneath the Lovell telescope and test the echo.

The Jodrell Visitors’ Centre also do science outreach events. They host school visits, for children of all ages. If you take a Physics A level group there, you can have real professional research astrophysicist come and talk to the class. The Observatory also teaches undergraduate, and PhD, students.

And so on, and so on.

In an era where we science-geeks are continually told to do our bit to inform the public about what we do, and “engage” with them, you would have thought Jodrell exemplified exactly how these things ought to be done.

So what is happening?

Whoops – the government is cutting the funding for the major current research project at Jodrell. Because they have screwed up the budgeting.

The project this pays for is called “MERLIN”, which stands for Multi-Element Radio Linked Interferometer Network. Essentially it is a network of radio telescopes around the UK linked together. By linking them they can do radio-astronomy as if they were a super-large radio telescope. That is basically as much of it as I understand - I told you I was terrible at physics - so if you want to know more start reading here.

MERLIN cost £ 9 million or so to build, and costs £ 2.7 M a year to run, money that had been promised by a UK Govt Agency called the Science and Technology Facilities Council.(STFC). However, despite all the endless puffing about “record funding levels” and “a Golden Age for UK science funding” coming from Govt spokesmen, the STFC has had a 25% cut in its budget for these major projects and facilities, and the axe is now starting to fall.

Big cuts are to be made. And they say the MERLIN programme will be one of the things to go.

[The more cynical among you might think that cutting MERLIN possibly reflects two other things: first, the Govt doesn’t see the point of astronomy and astrophysics research, as it doesn’t have many wealth-generating spin-offs; and second, Jodrell Bank is in the North of England, rather than in the (electorally important) South-East.]

Obviously the cutting of MERLIN will be terrible news for the radio astronomy people. And for astrophysics generally. And it will waste the money already invested in building the thing.

But it will do more than that. Without the MERLIN project, it is a good bet that the entire Jodrell site will become uneconomic to run. Given that Jodrell’s parent University of Manchester has been having a bit of a financial belt-tightening, they are hardly going to be finding a spare £ 2.7 million a year.

So there is a very really chance that a centre of scientific excellence with a sixty-year tradition, an icon of UK science, a popular visitor attraction, and a place that every years encourages many thousands of kids to take a greater interest in science and the natural world, will shut. And all while ministers continue to make smarmy speeches full of ringing phrases about creating:

“…a society that is excited about science, values its importance, feels confident in its use, and supports a representative, well-qualified scientific workforce”.

Ian Pearson, Minister for Science and Innovation, speaking at the launch of the Public Engagement Beacon Scheme on 30 Jan 2008.

Nothing like “Joined-up thinking” in government, eh?

- I will leave you to think about that last one.

PS If you agree with me that cutting MERLIN and potentially shutting down the Jodrell Observatory is an utterly f*!ckwitted idea, and would like to tell the (Sub) Prime Minister what you think, there is an e-Petition you can sign here.

EDIT - Good grief - I find myself agreeing with something written in the Peoples’ Medical Journal, I mean, the Daily Mail. They have a good article about Jodrell, and its founder Bernard Lovell, here.

And finally…

A HANDY GUIDE to some of the things you can get for £ 2.7 Million:

- Annual cost to taxpayer of the MERLIN project at Jodrell Bank observatory

- Approximate amount of expenses claimed last year by cabinet ministers

- 40% of the cost of the recent refurbishment of the House of Commons wine cellars*

- Annual salaries of four average Premiership footballers (approx £ 0.65 million pa each)

- Amount Chelsea football star Frank Lampard Jr, and TV Personawity Jonathan Ross, are each rumoured to earn in around five months.

- Approximate cost of British military spending on operations in Iraq and Afghanistan every SEVEN HOURS**

*See 6^th March entry here

**Based on March 10th figures from House of Commons Defence Ctte giving an estimated cost of £ 3.3 Billion for the current financial year. Note that recent work by economists (e..g Nobel Prizewinner Prof Joseph Stiglitz) looking at US spending, and estimating “indirect” costs as well as directly attributable ones, suggest that the true cost may be several times higher than the “official” estimates.

What could be so fine… as to be alkaline (Warning: Irony)

draust — Sat, 01 Mar 2008 21:22:07 +0000

Just in case you weren’t confused enough about water, the Alt-oids (my new favourite word for Alt Health boosters) have another Health Mystification Message for you.

In a health context water is a simple story: I would summarize it as “drink clean tap water, or some other liquid, when you feel thirsty”.

However, there is more money in telling people water is a really complicated business, which is what the Alt-oids do. For instance:

“Water” they tell you solemnly “is ONLY good for you when it’s ALKALINE”

Hmmm.

This message has been around for a while, but it has attracted my attention anew as I spotted that one of the online AltMed retailers I occasionally check out is now pushing pH papers as a health aid.

Yes, pH papers. Little books of strips of a special paper that changes colour when you dip it in fluids of different pH (acidity / alkalinity). Apart from in school chemistry, you may have met these papers if you keep tropical fish, or Koi carp.

Now you can buy these papers to check quickly if your body has the appropriate acidity / alkalinity.

Er… no you can’t, actually.

You certainly can buy the paper, and test the pH of your spit or wee, which is what the sellers suggest. This will, however, tell you Sweet FA about your “body’s pH balance”.

Apart from anything else, spit and wee have left your body, at least as physiologists and doctors mostly view it. These are secreted fluids. They are just temporarily residing in a compartment which is surrounded by your body. But they are separated from the real inside of your body by a layer of cells, or sometimes several layers.

To test body acid-base status you would have to take an arterial blood sample (to measure your arterial blood gases) – and believe me, you don’t want to do that without a good reason. Especially since, no matter WHAT reading the pH papers give in your spit or wee, there is almost certainly bugger all wrong with your body acid-base status.

You would know if there was, because you would be feeling distinctly ill.

First the pH papers… then, the Water Alkalinizer^TM…!

Of course, the selling of the pH papers can be just the set-up for a bigger pay-off. This is that you are “too acid”, either because you ”eat acid foods” (a subject for a future post), or because you “drink water that isn’t alkalinized”.

The second of these is a real money-spinner. For example the company I mentioned that is selling the pH papers also sells water alkalinizing systems for anywhere between £ 449 and £ 1249 (roughly 900-2500 $ US). Some health food stores I have seen have these systems and use them to sell “alkalinized water” in bottles, or by the glass.

The summary word for all this is: bullshit.

And, to re-emphasise one of my recurring themes, based once again upon confusing you, and convincing you that something normal is BAD for you - the normal here being poor old unloved tap water.

The first, and most blindingly obvious reason, that this is tripe is as follows:

Pure water really doesn’t have a terribly meaningful pH value, and will assume the pH of whatever you mix it with.

So how do you get “alkaline” water?

Well, from small amounts of dissolved salts that “confer” and “hold” the pH (the relative acidity or alkalinity). “Acid rain” is acid because it contains small amounts of salts derived from dissolved acidic gases like SO₃ and NO₂.

But…. tap water contains rather little in the way of dissolved salts. And the pH of a sample of water can be changed easily – by mixing it with something with a different pH. Like a solution of stomach acid, the stuff your stomach keeps in there to kill any little bugs you swallow that might make you ill, and also to help digest your food.

Furthermore, simple high school / GCSE Chemistry tells you that the “alkaline water” line is a crock. Because the extent to which a solution “holds” its pH value depends on something called the buffer power, which depends specifically on those substances dissolved in the water that can ”buffer” pH. This is something that anyone who did GCSE Chemistry has not only heard of, but has often seen with their own eyes.

Scientists commonly use pH buffers to “set” the pH of solutions they use in experiments to get biological processes to work properly. You need the right pH for the reaction. Different buffer substances have different pH values (or ranges, more accurately) over which they are good at buffering.

In your body, the most important buffer system consists of the “pairing” of carbon dioxide (CO₂) and bicarbonate (HCO₃^-), both of which are closely controlled to keep your “body acid base status” constant and your internal body pH (in your blood, and in your cells) around 7.4 (slightly alkaline).

Back to buffering school

To explain buffering simply: Take a weakly-buffered solution, containing a small amount - say 1 mM (1 milliMole per litre, 10^-3 Moles / litre) - of a pH buffer substance, and with a pH of 7.0 (neutral). The pH of this weakly buffered solution will fall (go acid) if you drip a drop of strong acid – like HCl, hydrochloric acid - into it. The small amount of pH buffer can’t “defend” the pH of 7.0 very well.

In contrast, a solution of 20 mM pH buffer at pH 7.0 is much more strongly buffered – 20 times as much – and the pH will barely twitch if you drip in the same amount of HCl as in the last example. The pH buffer substance “buffers”- protects – the solution pH of 7.0.

This buffering can also be shown by doing the kind of titration lots of people have done as a school chemistry experiment . You take a solution of a pH buffer in a beaker, add a colour-change pH indicator (something that will change colour when the pH changes substantially from alkaline to acid, or vice versa) and titrate in acid or alkali from a burette. The more concentrated the buffer solution you start with in your beaker, the more acid or alkali you have to add from the burette to get the pH in the beaker to change. Typically you add some, and add some, and add some, and then finally the colour suddenly changes.

What is happening is that as you add acid (say) from the burette it is being “mopped up” by the pH buffer – so that pH only changes a little, and the colour doesn’t change.

Only when all the buffer in the beaker has been consumed in mopping up the added acid does a BIG drop in pH (acidification) occur. And that is when the colour changes.

This simple experiment, which is a kind of special version of the acid-base_titration done by literally millions of kids over the last half-century or more, is actually one of the keys to understanding how your body copes with acids and bases. But more about that in a later post.

From these buffer chemistry examples, it should be intuitively obvious that when you mix two solutions of different pH “more buffer wins”. If you mix a solution containing 20 mM pH buffer at pH X with an equal volume of a solution containing 1 mM buffer at pH Y, the final pH will end up near the starting pH of the 20 mM buffer solution. – pH X.

So why does this kick the “Alkaline water” scam into touch?

Well, water will rarely have more than 1-2 mM dissolved salts in it. The main salt that acts as a pH buffer is bicarbonate (HCO₃^-), derived from dissolved CO₂. Let’s say, for the sake or argument, that the water you drink has 1 mM HCO₃^- in it.

Your body fluids (all of them) usually contain about 20 mM HCO₃^-. So if I were to mix a litre of water at any pH with a litre of ANY “body fluid” at pH 7.4, the pH of the body fluid would barely be touched.

And there is actually about 45 litres of well-buffered body fluid in my 80 kg body, not one litre. You do the calculation.

In fact, changing the pH of your drinking water won’t even change the pH in your stomach, let alone the rest of you.

Your stomach juice is a rather special secreted fluid; it is a solution of 80-130 mM HCl (hydrochloric acid) and has a pH or about 1-2 (strongly acid). This is its normal pH - with or without your having drunk “alkaline water”. So the pH of the water you drink will not even make a noticeable difference to the acidity of your stomach contents, let alone your body acid-base status.

For this reason, the pH of the water you drink is completely and utterly meaningless. It has hardly any physico-chemical meaning, and it certainly has zero practical significance.

Unless, of course, you are gullilble enough to be conned by the advertising pitch of the “alkaline water” snake oil salesmen.

Previous water posts:

Part 3: Glug glug glug – why those eight glasses a day don’t have to be water – or eight

Part 2: Drinking water can be deadly (not) pt 2: the men in grey suits… are actually on the case

Part 1: Drinking water – or bathing in it – can be deadly (not)