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Archive for the ‘Medicine/Health’ Category

Irrational rationality

Sunday, January 20th, 2008

“We have also arranged things so that almost no one understands science and technology. This is a prescription for disaster. We might get away with it for a while, but sooner or later this combustible mixture of ignorance and power is going to blow up in our faces.”
Carl Sagan

We seem to be in the midst of a retreat from rationality. At least, so say many commentators in the media at present, and judging by the online comments to their articles, many people appear to agree with them. They point to the rise of ‘New Ageism’ and other assorted ‘illogical’ beliefs like complementary and alternative therapies, bemoaning the failure of Joe Public to take on board the principles of robust science and calling for ever more stringent controls on the spread of such ‘preposterous nonsense’.

In many ways they seem to be right. Though whether this is any kind of ‘retreat’, who can say? Throwing the spotlight on areas that have been lurking in shadow often creates an illusion of some kind of a trend when really things have always been that way. We just didn’t see them before.

But as to where the ‘new’ irrationallism is evidencing itself, well that’s another matter entirely. More and more it seems as if the accusatory finger ought to be pointing straight at its owner’s own reflection in the mirror.

As Holmes et al wrote in a 2006 paper entitled Deconstructing the evidence-based discourse in health sciences: truth, power and fascism. International Journal of Evidence Based Health 2006; 4: 180–186,

“… the evidence-based movement in the health sciences is outrageously exclusionary and dangerously normative with regards to scientific knowledge. As such, we assert that the evidence-based movement in health sciences constitutes a good example of microfascism at play in the contemporary scientific arena. The philosophical work of Deleuze and Guattari proves to be useful in showing how health sciences are colonised (territorialised) by an all-encompassing scientific research paradigm – that of post-positivism – but also and foremost in showing the process by which a dominant ideology comes to exclude alternative forms of knowledge, therefore acting as a fascist structure.”

Such behaviour might be understandable, but it’s neither rational, nor scientific. The scientific method dictates that theory must always give way to evidence and that, no matter how successful the theory, if the evidence challenges it, then it’s the theory that must adapt. Successful theories mustbe able to explain and predict events which they attempt to describe with precision. Yet increasingly we’re seeing attempts to preserve scientific orthodoxy by denial of conflicting evidence.

At this point in time we’re presented with a situation summed up very well in a 2002 paper by Richard Shoup, Anomalies and Constraints:. Can Clairvoyance, Precognition, and Psychokinesis. Be Accommodated within Known Physics? Journal of Scientific Exploration, 2002; 16; 1, pp3–18.

“Arguably, nowhere in the history of mankind has common human experience so strongly conflicted with mainstream scientific opinion.”

The paper refers to psi phenomena, but Shoup could just as well have been writing about medicine. Crtically, since science can only ever reflect a uniquely human understanding of a uniquely human experience of existence, this discontinuity throws into stark relief the extent to which science is failing its own precepts. Science has become scientism.

It’s interesting too, in this context, that we’re seeing a rise in fundamentalist interpretations of scientific theory which seem to closely parallel the rise in religious fundamentalism. Both are pursued with missionary zeal by some very noisy and angry people. Both seek to make their points of view “the rule” for everyone else to abide by.

Perhaps this is no bad thing in some ways – such attempts to enforce rules which make little sense to large numbers of people generally result in people rejecting them in favour of something more sensible. It doesn’t take too much imagination to see that the fundamentalists could soon end up as marginalised minorities while the rest of us adopt a more pragmatic and humane approach to a genuine congruence with experience in both science and spirituality.

“In the Garden of gentle sanity may you be bombarded by coconuts of wakefulness.”
Vidyadhara Chögyam Trungpa Rinpoche



Kind of tragic

Saturday, November 17th, 2007

“We read the world wrong and say that it deceives us.”
Rabindranath Tagore

The homeophobes (a term coined by Jeanette Winterson in her Guardian article In Defence of Homeopathy this week) really seem to have the bit between their teeth these days. Yesterday’s publication of The Lancet revealed a comment piece penned by none other than Ben Goldacre, which he supplemented by a more emotive piece, A Kind of Magic?, saying much the same thing in the Guardian.

While recognising the utter pointlessness of arguing back – irreconcilable systems of thought can’t be reconciled in each other’s terms but only by a system of higher order, a metatheory that can encompass both (see Unscientific Attachment for more on this) – I felt Goldacre has had things his own way for quite long enough and it was time to send a letter to the Guardian. Whether it’s published or not is another matter, of course, but here it is in any case.

Sirs

In his November 16 Bad Science article A Kind of Magic?, Ben Goldacre writes: “This is all good fun, but my adamant stance, that I absolutely lack any authority, is key: because this is not about one man’s opinion …”

Unfortunately Dr Goldacre seems somewhat deluded on this point. This is very much about one man’s opinion (and a few others like him). He seems very fond of assuming the mantle of ‘science’ and claiming to speak in its name. However, ‘science’ does not speak with one voice – if it did, it wouldn’t be science – and his oft-repeated mantra that homeopathy avoids scientific scrutiny and that there’s no proof for its efficacy is complete nonscience. There are many people within the boundaries of what Dr Goldacre might define as ‘science’ working hard on the subject, and a large number of high quality trials testing the therapy in terms of its principles as well as its remedies have now been published.

So many, in fact, that the 2005 Shang et al meta-analysis which featured in The Lancet’s last attempt to dismiss homeopathy identified 110 which matched their stringent criteria for inclusion. Why that 110 was reduced to 8 unidentified trials in the final analysis still remains to be answered. At the very least this was a violation of transparency which should never have passed peer review. The analysis also failed to make any comparison between the homeopathic and conventional trials it finally selected. Could that be because there was no statistical difference between the two interventions? So if homeopathy is nothing but placebo, and conventional medicine no better, why is the NHS teetering towards bankruptcy because of the amount it has to spend on drugs, which, according to a 2000 study in the Journal of the American Medical Association, are responsible for over 106,000 deaths annually in the US through side effects alone? We should all be on placebo!

Dr Goldacre holds up randomized controlled trials as the gold standard in evidence-based medicine but seems to forget that these are what they are – trials. It’s estimated that up to one fifth of all new prescription drugs may eventually be recalled or produce potentially harmful side effects (JAMA again, 2002). A 20% failure rate is not much of a gold standard. The gold standard for evidence-based medicine is surely “does it work in practice”? There are now several large-scale long-term clinical studies of homeopathy showing that it not only produces outcomes comparable with conventional medicine, but in some cases (a 2005 German study by Witt et al) better. A 2002 literature review by an Italian Advisory Board came to the same conclusion.

His adherence to the dogma that homeopathy’s use of extreme dilutions renders any potential action impossible is mistaking the map for the territory and ” … relies on a quaint old idea from the nineteenth century that the ONLY way that the property of water can be affected or changed is by incorporating foreign molecules. This is the Avogadro-limit high-school level chemistry argument. To a materials scientist this notion is absurd, since the fundamental paradigm of materials-science is that the structure-property relationship is the basic determinant of everything. It is a fact that the structure of water and therefore the informational content of water can be altered in infinite ways.” ?(Prof Rustum Roy PhD, Evan Pugh Professor of the Solid State Emeritus; Professor of Science, Technology and Society Emeritus; Professor of Geochemistry Emeritus, Pennsylvania State University).

Dr Goldacre may not value patient choice, but the interests of evidence-based medicine alone would seem to be demanding that he indulge in a little more scientific study and a little less opinionated prejudice. The research is all there and it would be kind of tragic if a valid and effective therapeutic option were lost to us for no good reason other than that it violates our present consensus conception of how the world works. The core of the scientific method is that if the evidence contradicts the theory then it’s the theory that gets questioned.

Yours etc

“There are two ways to be fooled. One is to believe what isn’t true; the other is to refuse to believe what is true.”
Søren Kierkegaard



Homeopathy: the scientific proofs of efficacy

Monday, November 12th, 2007

“The opposite of a fact is falsehood, but the opposite of one profound truth may very well be another profound truth.”
Niels Bohr

“The world of homeopathic research is moving in the direction of investigating its rational, explicable, demonstrable, reproducible aspects and neglecting the more controversial and doubtful aspects. The purpose of this publication is to review the extensive literature available, and draw the reader’s attention to studies that comply with the strictest scientific methodologies.”

This Italian literature review, published in 2002, is available in English translation from the Italian homeopathic pharmacy Guna, and presents a comprehensive review of the trials of the last decade, summarised by an Advisory Board which includes professors in Immunology, Pharmacology, General Surgery, Clinical Morphology and Anatomy, Human Physiology, Psychiatry and Neurology from universities and medical schools in Italy, the US, Germany and Poland. Some salient quotations from the study:

“A number of large-scale studies designed to evaluate the huge amount of homeopathic literature have been conducted, especially in the last 10 years. Organisations and institutes of great international prestige and importance have dealt with the issue of homeopathy. All of them have concluded that homeopathy possesses therapeutic efficacy.” (Overview of Human Clinical Trials, p29)

“… most of the members of the medical profession and the media have failed to perceive the existence of this body of studies, which demonstrate the therapeutic efficacy of homeopathic medicines. The aim of the present volume was to fill this lack of information by a compendium made of some of the latest and most significant literature in the field.
Very briefly, a large body of studies demonstrates that the efficacy of homeopathic medicines is not due to the “mythical” placebo effect, thus finally dispelling a series of superficial, prejudiced attitudes.

“Among these, a set of studies compare homeopathic vs allopathic medicines. These trials were conducted in accordance with Helsinki Declaration on the therapeutic efficacy.
Most of the best studies relate to the branch of homeopathy known as homotoxicology which, with its pragmatic attitude and rejection of therapeutic extremism, seems to meet current demand for integrated medicine most effectively.
These studies demonstrate that the effect of homeopathic medicines may be at least similar to that of the allopathic reference drug used for the same disorder. They also confirm that homeopathic medicines, unlike allopathic drugs, rarely produce side effects. Finally, they show that homeopathic remedies are usually cheaper,and in some cases much cheaper, than the corresponding conventional treatment.

“Everybody is entitled to his own opinion and can deny the evidence, even when faced with the clearest proof. But who hold public and institutional offices and responsibilities have the duty to analyse actively all the body of information that may improve the patient’s quality of life.

[...]

“It may seem paradoxical that tiny amounts of an active constituent (diluted by the very special process of homeopathic production) can produce effects on living beings, but this is evidently a scientific fact.
Science acts on the basis of objective, verifiable observations; if the event demonstrated cannot be interpreted by a theory, it is the theory that needs to be revised. This is the principle behind the progress of science.” (Conclusions, p87-88)

This study was published in 2002. In 2005, the World Health Organisation were in the process of compiling what was believed to be a largely positive report on homeopathy, and which was apparently leaked to The Lancet in advance of its publication of the Shang et al meta-analysis. According to Dr Peter Fisher, Director of Research at the Royal London Homeopathic Hospital and the Queen’s homeopath:

“The same issue of The Lancet featured a leak of the World Health Organisation’s (WHO) draft report on homeopathy. The WHO document was apparently leaked to The Lancet by Dutch and Belgian doctors hostile to homeopathy; their comments and the (hostile) comments of Prof. Edzard Ernst of the University of Exeter were published. Dr Xiaorui Zhang, Traditional Medicine Coordinator of WHO, who is responsible for the report, was also interviewed, but declined to comment on a leaked, confidential draft. This leak came only 2 days after The Times of London published, as its front page lead, a remarkably similar story: a leak of the Smallwood Enquiry on The Role of Complementary and Alternative Medicine in the NHS commissioned by The Prince of Wales’ Foundation for Integrated Health. It is ironic that the editor of The Lancet, Dr Richard Horton, wrote to The Times accusing Prof. Ernst of having ‘broken every code of scientific behaviour’ for leaking the draft report of the Smallwood Enquiry (and incidentally describing complementary medicine as ‘a largely pernicious influence… preying on the fears and uncertainties of the sick’), while simultaneously doing the same to the WHO report in his own journal!

“Dr Horton also wrote an open letter to the UK Secretary of State for Health, Patricia Hewitt and the Chairman of the National Institute for Clinical Excellence (NICE) Prof. Sir Michael Rawlings, calling for the use of homeopathy in the NHS to be reviewed in light of this publication.”

What we appear to be looking at here is a very deliberate attempt to discredit homeopathy, allowing prejudice to hold sway over the results of scientific studies and making a mockery of evidence-based medicine. Not only are these individuals attempting to mislead the medical profession and general public, but are trying to deprive them of the right to choose and use a healthcare modality which is rapidly being reliably demonstrated as at least as effective as conventional medicine, and in some instances, more so. Futher, one that is also proving itself to be considerably cheaper than the present model and highly unlikely to kill upwards of 106,000 people per annum (in the US alone – Journal of the American Medical Association 2000;284:483-485) just through the side effects of the medication.

If The Lancet remains true to previous form in its next issue on homeopathy, then it doesn’t look like it has much future as a respected scientific journal under its present stewardship. That’s a shame, as it’s one of the oldest peer-reviewed medical journals in the world (founded in 1823). Homeopathy will survive, as it has done for longer than The Lancet despite all previous attempts to suppress it, because the truth has a way of finding its way out regardless.

If you support freedom of choice in healthcare and have had good experience of homeopathic treatment, you can register your support by signing the “homeopathy worked for me” declaration.

“In a time of universal deceit, telling the truth becomes a revolutionary act.”
George Orwell



Then they laugh at you

Sunday, September 16th, 2007

Mahatma Gandhi

“First they ignore you, then they laugh at you, then they fight you, then you win.”
Mahatma Gandhi

In the wake of yesterday’s piece by Ben Goldacre in The Guardian (Stick to sugar pills and avoid the hard stuff), gleefully ridiculing homeopathy once again, I found Gandhi’s words (left) coming to me loud and clear as they frequently do when I read articles like this. Now there was a man who knew a thing or too about bringing about sea-changes in prevailing opinion …

Things are running true to form, just as Gandhi predicts. For years homeopathy was ignored as a complete irrelevance, then laughed out of court. Now people are taking it a bit more seriously, we’re into the fighting stage, with the ridiculers continuing to throw their weight in now and again.

A cursory apprehension of Goldacre’s point of view might seem plausible enough, but it doesn’t stand up to scrutiny. What is glaringly obvious to anyone who has anything beyond the most superficial acquaintance with the therapy is that he, and other professional detractors such as Professor David Colquhoun, have never bothered to go further than the prejudice on the ends of their noses to understand why so many people – both patients and practitioners – abandon conventional medicine in favour of it.

Is that good science? Hmmmm …

To attempt to dismiss so many people, among whom will inevitably be a good proportion of rational and intelligent individuals, as misguided fools (or worse) seems more than just a little foolish.

The entire content of Goldacre’s piece comes across as mostly supposition – a set of opinions based on a few choice snippets of information taken out of context, much as American schoolkids’ essays on London often wax lyrical about fog. Goldacre’s assertion that “Peddling fiction is the homeopath’s trade” is typical of the logic that he and his ilk resort to employing in order to support their viewpoints, when in fact what they are peddling is the fiction – a view of homeopathy that coalesces out of the fog of their imagination and bears little or no resemblance to the actuality of daily homeopathic practice in any of its myriad permutations. The notion that all homeopaths are liars, cheats and frauds because what they’re doing can’t be “true” is not a very scientific argument, is it? In fact, it’s on a par with racism. Perhaps The Guardian should send Dr Goldacre out to India to experience the no-nonsense frontline of the therapy in a busy homeopathic hospital, where they treat “the hard stuff” every day. It would be interesting to see how long his theories about what constitutes ‘evidence’ hold up.

Such being the nature of projection, Goldacre is of course massively guilty of the ‘Bad Science’ his column purportedly stands against. Though what is really at issue here is the nature of “proof” itself and the belief in an objectively determinable “reality”. For more on this subject, see my series of essays starting with Unscientific Attachment.

“In theory, theory and practice are the same, but in practice they’re different.”
Unknown



A shot in the arm for sense

Thursday, April 12th, 2007

Drugs

“An error does not become truth by reason of multiplied propagation, nor does truth become error because nobody sees it.”
Mahatma Gandhi

At last! Science is finally starting to talk sense about our completely irrational societal attitudes in discriminating between legal and illegal drugs.

The present Misuse of Drugs Act 1971 in the UK specifies the maximum penalties for Class A drugs which Include: Ecstasy, LSD, heroin, cocaine, crack, magic mushrooms (if prepared for use) amphetamines (if prepared for injection). The penalties for possession: up to seven years in prison or an unlimited fine. Or both. Penalties for dealing: up to life in prison or an unlimited fine. Or both.

The classification of drugs into classes A, B and C is supposed to be based on a scientific assessment of the risk of substances so classified to individual health, and to society by people under their influence. However, to anyone who’s conducted their own experiments into the effects of many of these drugs, or to those working with people who’ve become addicted to them, the arbitrary and often irrational classification system – particularly in its exclusion of the societally-sanctioned drugs alcohol and tobacco – has been open to serious question for some considerable time. At least 40 years. In research published in The Lancet on March 24, the authors of a comprehensive new assessment of varying ‘harmful’ criteria attributable to each classified drug conclude

“Our findings raise questions about the validity of the current Misuse of Drugs Act classification, despite the fact that it is nominally based on an assessment of risk to users and society. The discrepancies between our findings and current classifications are especially striking in relation to psychedelic-type drugs. Our results also emphasise that the exclusion of alcohol and tobacco from the Misuse of Drugs Act is, from a scientific perspective, arbitrary. We saw no clear distinction between socially acceptable and illicit substances. The fact that the two most widely used legal drugs lie in the upper half of the ranking of harm is surely important information that should be taken into account in public debate on illegal drug use. Discussions based on a formal assessment of harm rather than on prejudice and assumptions might help society to engage in a more rational debate about the relative risks and harms of drugs.”
(Nutt, David, King, Lesley A, Saulsbury, William and Blakemore, Colin. Development of a rational scale to assess the harm of drugs of potential misuse. The Lancet 2007; 369:1047-1053)

According to the study’s rankings, alcohol deserves a Class A classification, and tobacco a Class B. Against this simple rational assessment, the hysteria surrounding illegal drugs use seems not only hypocritical but ludicrous. (Doubly so when seen in the light of the pharmaceutical industry’s best efforts to ensure that the majority of the population are dependent on their products for life …) This is not to say that the effects of drug addiction – illegal or legal – are to be taken lightly, but that labelling a substance ‘legal’ or ‘illegal’ does absolutely nothing to contribute to understanding or addressing the underlying problems that lead people into a path of addiction and harm. Neither does it overly discourage those who enjoy a good party, but the illegality disguises the fact that many substances can be and are enjoyed with responsibly and moderation, just as alcohol can, when there’s no push-me-pull-you of stigma or ‘forbdden fruit’ attached to it.

Isn’t it obvious that a desire to habitually over-indulge in any mood/perspective-altering substance is not ’caused’ by the substance itself, but stems mainly from frustration, discomfort, even desperation, with the mood/perspective/situation that the person’s in prior to taking the substance? Attempting to remove the means to escape doesn’t solve the problem, and though some of these substances do themselves actively contribute to a cycle of dependence, this isn’t how dependency begins and is not the sole factor in how it’s maintained. Demonising the substance in a wave of hysterical over-reaction not only obscures the real problem but frustrates the development of a culture of responsible use for recreation and enjoyment.

Is it too much to hope for that some of the conclusions from this study might supplant the fear-based hype that masquerades as the drugs ‘education’ currently delivered to our children in schools? If we really want to protect them from harm, as opposed to merely educating them in the nature of propaganda, we need to tell them the truth. Sooner or later, the more adventurous ones find that out for themselves, and word soon spreads, so in this context what the ‘education’ achieves is to leave kids on their own to experiment with what safe and responsible use is all about, and gives them yet another reason to take what adults tell them with a very large pinch of salt. Or something else …



DISCLAIMER
Thanks to the current insanity revolving around homeopathy in this country, in both media and blogosphere, it's become necessary to insult your intelligence by explicitly drawing your attention to the obvious fact that any views or advice in this weblog/website are, unless stated otherwise, the opinions of the author alone and should not be taken as a substitute for medical advice or treatment. If you choose to take anything from here that might be construed as advice, you do so entirely under your own recognisance and responsibility.

smeddum.net - Blog: Confessions of a Serial Prover. Weblog on homeopathy, health and related subjects by homeopathic practitioner Wendy Howard