Podcast plug – Dr Aust live (ish)

In which Dr Aust does some heavy breathing into a headset.

A week or so back, thanks to the wonders of internet-based communication technology (aka Skype) I joined the guys from Greater Manchester Skeptics for their podcast Just Skeptics (Episode 12, apparently). It is now out – if you’re interested, you can listen to it here, or here, or even download it (free, of course) from the iTunes store.

You’ll have to excuse the heavy breathing, which I’m embarrassed to say was me. I’d never used a microphone headset before – I’d only installed Skype a day or two earlier – and I think the microphone distance needs adjusting. Or perhaps I’m just a heavy breather.

Anyway, if you do fancy checking it out, you can first hear us talking about “Charity mugging”, the phenomenon whereby you can’t walk twenty metres in a British town centre in the daytime without being accosted by someone trying to sign you up as a charity (direct debit) donor. Until the podcast I hadn’t heard that these “Chuggers” are often out-of-work actors.

We also discuss mad chemists, that hardy stereotype of the man in the white coat with the mad staring eyes. This was inspired by the UK Government’s “Crazy Chemist” anti-drug campaign – the one that got the Royal Society of Chemistry so hot under the collar.

And finally, at 24 minutes in, you can hear me having my “Soapbox” where I poke fun at Alternative Medicine. It’s not terribly original stuff, and will probably be fairly familiar to regular readers, but hopefully you might find some of it amusing.  This segment is followed by a discussion of similar themes, which runs for most of the rest of the podcast. It  concludes with the Richard Feynman reflexology story that you may remember from here.

Anyway, let me know what you think, especially if you stick it out all the way through.

PS Listening to the podcast I now notice a couple of minor factual inaccuracies on my part, notably giving the wrong name for something… ah well. Shows that talking off the cuff is not as easy as one might think. Try to spot the slip(s), if you like.

Feynman on foot fondling

In which Dr Aust muses on foot flim-flam.

The night before last I went along to a rather good Skeptics in the Pub talk by the excellent Simon Perry.

As Simon was going through the ways he had got interested in debunking preposterous claims by Alt therapists, he mentioned Reflexology as being one of the first Alt.Therapies that had caught his eye.

Reflexology, for anyone that doesn’t know, is one of the more laughably daft quackeries, especially popular with New Age types. It is based on the idea – needless to say, an idea with no kind of basis in anatomy, or anything else – that a “map” of the body’s areas can be found on the sole of the foot, and that massaging these areas can help with the “mapped” bit of you.

Like many a choice quackery, reflexology in the form we now have it is a surprisingly recent invention. As the Wikipedia page on reflexology explains, it dates from around the time of the First World War, and was then elaborated and codified in the 30s and 40s. It gained greatly in popularity  during the 60s and 70s, when Woo became fashionable along with other kinds of mysticism and “stoned thinking”. I am in two minds whether to blame Marin County or the Glastonbury Festival.

Less surprisingly, reflexologists like to claim that reflexology is based on “Ancient Healing Wisdom”.

Now…. where have I heard that before? Oh yes, for just about every piece of Alt.Therapy  quackery you can possibly think of.

The Association of Reflexologists – yes, I’m afraid they have an association – tells us:

“The art of reflexology dates back to Ancient Egypt, India and China”

Fancy, just like chiropractic. Now who’d have thought it?

Now, I don’t know if the reflexologists have followed the chiropractors in being miraculously able to detect the practice of their Nonsense of Choice“Art” back to before there were actual written records – remarkable how they manage to do that – but I wouldn’t be terribly surprised. It is amazing just how ancient that ol’ wisdom becomes when you are trying to sell it to folks. Just sayin’.

When the topic of reflexology comes up, as it did in conversation with one of my Nursing degree student groups the other day, I am given to referring to it as:

“A pricey foot massage with added Mumbo-Jumbo.”

– a description I like to think even my friend  David Colquhoun might approve of, since it is shorter than the potted summary of reflexology in his Patients’ Guide to Magic Medicine.

There’s no Woo too far…

Now,  it is a measure of just how much mainstream medicine currently bends over backwards to be respectful of complementary medicine (CAM) – and quite contrary, by the way, to what the CAM advocates, who always complain they are not taken seriously enough, would have you believe – that there have been quite a number of randomised controlled trials of reflexology. I shit you not.  Indeed, there is  a recent Systematic Review of them by the ever-punctilious Edzard Ernst:

————————————————————————————————————

Med J Aust. 2009 Sep 7;191(5):263-6.
Is reflexology an effective intervention? A systematic review of randomised controlled trials.
Ernst E.

Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, United Kingdom. Edzard.Ernst@pms.ac.uk

Abstract

OBJECTIVE: To evaluate the evidence for and against the effectiveness of reflexology for treating any medical condition. DATA SOURCES: Six electronic databases were searched from their inception to February 2009 to identify all relevant randomised controlled trials (RCTs). No language restrictions were applied. STUDY SELECTION AND DATA EXTRACTION: RCTs of reflexology delivered by trained reflexologists to patients with specific medical conditions. Condition studied, study design and controls, primary outcome measures, follow-up, and main results were extracted. DATA SYNTHESIS: 18 RCTs met all the inclusion criteria. The studies examined a range of conditions: anovulation, asthma, back pain, dementia, diabetes, cancer, foot oedema in pregnancy, headache, irritable bowel syndrome, menopause, multiple sclerosis, the postoperative state and premenstrual syndrome. There were > 1 studies for asthma, the postoperative state, cancer palliation and multiple sclerosis. Five RCTs yielded positive results. Methodological quality was evaluated using the Jadad scale. The methodological quality was often poor, and sample sizes were generally low. Most higher-quality trials did not generate positive findings. CONCLUSION: The best evidence available to date does not demonstrate convincingly that reflexology is an effective treatment for any medical condition.

PMID: 19740047

————————————————————————————————————-

Good Old Edzard. How he keeps a straight face whilst reviewing this kind of ridiculous “Prior Probability Zero” nonsense I really don’t know. I am damn sure I wouldn’t be able to.

[An aside to  explain why not: a decade or so ago I turned down a final interview for a rather better paid job (better paid than being a junior academic) as a mid-level administrator for a Large and Important Medical Charity. A big part of my decision was that it was clear that an atmosphere of High and Hushed Seriousness was a major part of their Headquarters House Style. It was clear to me that High Seriousness was not something I would be able to stick to for that long, being a person naturally given to Low and Childish Mockery.]

Anyway, getting back to the estimable Professor Ernst, he is a treasure, partly because he is able to do what he does with complete seriousness and great thoroughness. I suggest we should have a slogan for him:

“Prof Edzard Ernst: rigorously appraising Alt.Med research, so that you don’t have to.“

– and, indeed, long may he continue to do so.

Finally – Feynman on Foot Flim-Flam

Anyway, the point of this post, before it got sidetracked, was to say

(i) that Simon Perry gives an excellent talk, and

(ii) that reflexology is (to use a piece of British vernacular) “Bollocks”.

And finally, to re-tell a story.

I happened to ask Simon Perry if he had heard Richard Feynman’s reflexology story. He hadn’t, which makes me think it is not as well known as it could be. So I will reproduce it here. It comes from one of my favourite pieces of Feynman’s debunking work, his famous talk on “Cargo Cult Science”. The talk was given originally in 1974, at the Caltech (California Institute of Technology) Commencement Address, but thirty-six years later it remains just as apposite.

I shall leave the rest to the master:

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“During the Middle Ages there were all kinds of crazy ideas, such as that a piece of rhinoceros horn would increase potency. Then a method was discovered for separating the ideas–which was to try one to see if it worked, and if it didn’t work, to eliminate it. This method became organized, of course, into science. And it developed very well, so that we are now in the scientific age. It is such a scientific age, in fact, that we have difficulty in understanding how witch doctors could ever have existed, when nothing that they proposed ever really worked–or very little of it did.

But even today I meet lots of people who sooner or later get me into a conversation about UFOs, or astrology, or some form of mysticism, expanded consciousness, new types of awareness, ESP, and so forth. And I’ve concluded that it’s not a scientific world.

Most people believe so many wonderful things that I decided to investigate why they did. And what has been referred to as my curiosity for investigation has landed me in a difficulty where I found so much junk that I’m overwhelmed. First I started out by investigating various ideas of mysticism and mystic experiences. I went into isolation tanks and got many hours of hallucinations, so I know something about that. Then I went to Esalen, which is a hotbed of this kind of thought (it’s a wonderful place; you should go visit there). Then I became overwhelmed. I didn’t realize how MUCH there was.

At Esalen there are some large baths fed by hot springs situated on a ledge about thirty feet above the ocean. One of my most pleasurable experiences has been to sit in one of those baths and watch the waves crashing onto the rocky slope below, to gaze into the clear blue sky above, and to study a beautiful nude as she quietly appears and settles into the bath with me.

One time I sat down in a bath where there was a beautiful girl sitting with a guy who didn’t seem to know her. Right away I began thinking, “Gee! How am I gonna get started talking to this beautiful nude woman?”

I’m trying to figure out what to say, when the guy says to her, “I’m, uh, studying massage. Could I practice on you?” “Sure,” she says. They get out of the bath and she lies down on a massage table nearby. I think to myself, “What a nifty line! I can never think of anything like that!” He starts to rub her big toe. “I think I feel it,” he says. “I feel a kind of dent–is that the pituitary?” I blurt out, “You’re a helluva long way from the pituitary, man!” They looked at me, horrified–I had blown my cover–and said, “It’s reflexology!”

I quickly closed my eyes and appeared to be meditating.”

Richard P Feynman

Dr Michael Dixon is annoyed

In which Dr Aust spots that Prince Charles’ favourite GP is in a state of high dudgeon over people being mean about magic medicine. You know – being mean by asking about evidence, and other awkward stuff.

Dr Aust occasionally checks the website of the GPs’ magazine Pulse. This is partly because alerts to it appear on my email and in my Twitter feed.

It is also because the Pulse website has blogs on it; the three I read are by Prof Edzard Ernst, by that excellent blogger (and an on-line acquaintance of mine) the Jobbing Doctor, and by the rather exasperated and often very funny Phil Peverley.

It is a bit of a faff to read the articles at Pulse online because you have to register, but it is free to do so, and once you have, you get an interesting perspective on what is going on in what a lot of doctors I know call “GP-land”.

Including with respect to “complementary”  medicine.

The thing that caught my eye there recently was a distinctly splenetic article (as one splenetic middle-aged gentleman talking about another) written by Prince Charles’ favourite GP, Dr Michael Dixon OBE.

Dr Michael Dixon of the Prince's Foundation for Integrated Health

Dr Dixon is the medical director of the Prince of Wales’ Foundation for Integrated Health, probably the most influential lobby group promoting CAM in the UK.

In the article, Dr Dixon is evidently rather annoyed.

You can tell this from the very beginning, where he describes Edzard Ernst as

“A leading member of science’s militant tendency”

Dr Dixon also referes to his opponents – which seems to be anyone who thinks that CAM should live up to the same standards of evidence as the rest of medicine – as

“the new fundamentalists”

In fact, the whole paragraph that contains this phrase is worth quoting.

“The new fundamentalists rarely, if ever, think about the patient. That is not surprising. Most are not doctors. Even Professor Ernst hasn’t faced a real live patient for at least seventeen years. Those were the days when you could still, just, get away with ‘doctor knows best’. Seems he is still living that dream.”

The last bit of this is particularly smile-inducing – at least if you are a conoisseur of irony.

After all, who is it that is demanding the right to use hocus-pocus on the patients, and not explain exactly what is in the remedies?

Is it Professor Ernst?

Or is it Dr Dixon?

As one respondent puts it (read the article and then comments to find out who):

“It is the very essence of old fashioned paternalistic medicine to pretend that it’s a good idea to deceive the patient for the sake of eliciting a placebo reaction.”

While another commenter characterizes Dr Dixon’s extended harrumph (rather accurately in my view) as an “embarrassing diatribe”.

In fact, the main reason for mentioning Dr Dixon’s article is to draw your attention to the excellence of many of the comments that follow it, and which are well worth a read.

The commenters, as the phrase is, “take Dixon’s ass to school“.

Though I suspect his evident blind spots will mean he will not learn very much.

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PS   For anyone interested in what the medical ethicists think of homeopathy, and the ethical issues involved, the answer can be found here.

ADDED: And via Twitter, and courtesy of the splendidly eagle-eyed “Blue Wode”,  here are two other informative articles about Dr Dixon from Majikthyse and The Quackometer.

Keepin’ it unreal – again

Or: Homeopathic levels of accuracy

Observant readers may have spotted the new Dr Aust Twitter feed down at the bottom of the sidebar on the  blog.

Yes, that’s right – you can now follow Dr Aust on twitter, though I can’t really think why you would want to.

I had resisted signing up on Twitter until just a few days ago. I might bore you with the detailed reasons some other time, but the main one was that, as an Olympic-class procrastinator, I reckoned the last thing I needed was yet another way to procrastinate.

But – I now retract that statement. And Thank Goodness I signed up to Twitter this week.

Because late on Friday afternoon, at about 5 pm, Twitter gave me the best laugh I have had in a couple of months.

This was when several sceptical Tweets directed me to a truly marvellous example of Alternative, not to say Parallel, not to say Quantum Alternative Parallel Reality (“Quap Reality” for short). At which point, I laughed so hard I nearly fell out of my chair.

And it takes a lot to do that late on a Friday afternoon.

The cause was this article, from the notorious Journal of Alternative and Complementary Medicine, or JACM, entitled:

CAM, Free Speech, and the British Legal System:
Overstepping the Mark?

The author of this bravura piece of Unreality (could it be a spoof?) is homeopathic quantum intellectual supreme, Dr Lionel Milgrom.

Or to give him his full title from the paper, which I suspect he would insist on,  since he typically lists all the letters:

Lionel R. Milgrom, Ph.D., M.A.R.H., M.R.Hom., F.R.S.C.

Now, I had occasionally suspected hitherto that Lionel Milgrom had untapped comic talent. But he has outdone himself this time.

Only the first page of the opus is free access, but that is more than enough:

Abstract:

The British Chiropractic Association recently won a libel case against the science writer and CAM ‘skeptic’ Dr Simon Singh

(Italics mine)

As Private Eye like to say – “shurely shome mistake”?

There really can’t be that many people following the BCA v Singh case in even a casual way who don’t know that it is still ongoing.

There is, after all, hardly a lack of coverage, at least online.

While Milgrom’s article clearly went to press before the latest hearing in the case last week – the article has no “accepted on” date, but there is a reference in it that says “accessed Aug 24th 2009” – surely no-one was under the illusion that Sir David Eady had actually heard the full libel action?

Well, apparently some people were. It gets better:

“The judge agreed with this argument [i.e. that the use of the word “bogus” implied the BCA had knowingly lied about the evidence concerning chiropractic for various childhood ailments] awarding the BCA substantial damages.“

Truly bizarre. It was this sentence that had me speechless with laughter.

The first bit is OK – Eady did, in the main, accept the BCA’s pleaded meaning (this is the ruling that has just been sent back on appeal).

But “substantial damages”? Errr – NOT. Damages get awarded when the case is, like, finished.

(“Substantial Damages” , by the way, is a phrase usually used by successful libel complainants in their victorious press statements to imply that their opponents had been comprehensively slapped with the wet kipper, not to mention taken to the cleaners financially)

How very, VERY odd.

The remainder of Milgrom’s article, which sadly is behind a paywall, is a hoot too, but I will leave that for another time.

What I want to concentrate on now is the Sheer Unreality of it.

Unreality….

Unless….

Unless…

Unless there is some OTHER Quantum Alternative Parallel Reality, to which Milgrom perhaps has privileged access as a “Quantum Homeopath”, where what Milgrom says is actually true.

Of course!

How could I not have known?

Indeed, perhaps this “QUAP Reality” is where all the Alt.Reality folk hang out.

Once you have made that Leap into the Unreal, IT ALL BEGINS TO MAKE SENSE AT LAST.

In this Alternative Reality, of course the BCA won.

Indeed, this new Quantum Alternative Parallel Universe, or QUAP-iverse, seems to be especially favourable for Libel verdicts.

Remember how we saw at the start of this year, in “Keeping It Unreal”, that dropping a libel suit and getting landed with hundreds of thousands of pounds in legal costs was actually a huge VICTORY for noted Alternative Reality Figure Dr Matthias Rath?

Clearly, in the same (Un) Reality Rath seems to inhabit, the BCA have already won large damages, just as Milgrom states.

And then, of course, all the other seemingly daft stuff falls into place too.

– Diluting a substance makes it MORE powerful.
– Mystical laying on of hands beams out healing power.
– Illness is all in the Mind.
– Pushing on your arm can diagnose your allergies.
– Massaging your feet can magically rejuvenate your kidneys.
– Flushing your rear end with a load of warm water can magically “detox” your liver.
– Sticking you in a “Sweat lodge” and cooking you until you are dangerously dehydrated and hallucinating can be a “healing experience”

– and so on.

So – Silly Me.

There I was thinking these folk were all away with the fairies, when really they were simply privileged to be able to access a QUAP-iverse where all this stuff is really true.

——————————————————-

Or: I was right the first time.

They really ARE Away With The Fairies.

Tinfoil Hats And All.

In this rather party-pooping view, which Alt.Reality folk like to call “Scientism” – though I prefer “Reality” – the normal rules of physics and chemistry apply, homeopathic remedies are water, BCA v. Singh is still ongoing, all the daft “therapies”  I mentioned just now are a bunch of **!*, and Dr Milgrom has clearly not been checking his facts carefully enough.

And nor,  it would seem, has anyone else at the JACM.

(Chief Editor, if you didn’t know: Dr Kim “Dr Q-link” Jobst, FRCP).

Of course, Milgrom is on the JACM Editorial Board (you can see the full membership here), so one is curious whether such extended “Opinion Pieces” – the JACM actually calls the section in which the Milgrom piece features “Paradigms”, whatever they mean by that  – even get read by anyone apart from the author, if that author is a journal editor.

As to whether this apparent carelessness with facts is representative of other bits of Dr Milgrom’s oeuvre, or indeed of other content in the JACM –

– you might well wonder about that.

But – on the advice of my lawyers – I couldn’t possibly comment.