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Posts Tagged ‘Ben Goldacre’

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



PEKing out the bias

Sunday, November 11th, 2007

Lancet Vol 366, Issue 9487, 27 August 2005 

“Research is subordinated (not to a long-term social benefit) but to an immediate commercial profit. Currently, disease (not health) is one of the major sources of profit for the pharmaceutical industry, and the doctors are willing agents of those profits.”
Dr Pierre Bosquet, Nouvelle Critique, France, May 1961

As The Lancet prepares to publish another issue on homeopathy, this seems a suitable moment to republish a blog entry from 18 months ago which described the highly irregular context forming the backdrop to the publication of the seriously flawed study (Shang et al. ‘Are the clinical effects of homeopathy placebo effects? Comparative study of placebo controlled trials of homeopathy and allopathy’ The Lancet 2005;366 (9487):726-733) which claimed to support the conclusion that the effects of homeopathy are no more than placebo.

Further details on the study itself, analyses of it’s principal failings, and the reaction it provoked among serious researchers can be found on the Myths and Misconceptions page.

The Shang et al meta-analysis was an offshoot from a Swiss government study, the Programm Evaluation Komplementärmedizin (PEK), which was designed to allow politicians to assess whether or not five complementary therapies – anthroposophical medicine, homeopathy, neural therapy, phytotherapy and traditional Chinese herbal therapy – should be included in the list of services covered by the Swiss compulsory health insurance scheme (KLV). The cost of complementary therapies were, until 1998, reimbursed under the basic national scheme, but a change in the regulations in 1998 put the decision over which therapies were or were not valid for reimbursement in the hands of the Swiss Department of Internal Affairs (EDI). Public outcry forced the government to back-peddle and the five most popular therapies were reinstated in the KLV scheme from 1999 to 2005, on condition that each therapy was provided by FMH-certified physicians only, and that a simultaneous study in each therapy’s effectiveness was carried out (the PEK study). The decision on whether the therapies were retained within the basic health insurance scheme after 2005 would depend on the demonstration of their efficacy, appropriateness and cost effectiveness.

The study was set up under the Federal Office of Social Insurance (BSV) with a well-defined management structure and review board of internationally-acknowledged experts. It received widespread praise for the quality of its design and the degree of cooperation and transparency amongst its participants. As each area of the study began publishing their findings, the project was cited as an exemplar for future CAM research.

But as the extent of the findings in favour of the five therapies began to become clear, in 2004 PEK’s management structure was abruptly changed and the control of the study was passed to the Federal Office of Health (BAG). From that point onward, many attempts were made to interfere with and derail its emerging conclusions. Transparency was immediately compromised. Economic data showing the cost benefits of CAM were suppressed. The economist preparing to present the results of his work was dismissed without reason and placed under a gagging order. Other departments were prevented from publishing their work.

One member of the PEK steering committee, Dr med Peter Heusser, was so disgusted by what he witnessed that he has written an account of what happened, Medizin und Macht am Beispiel des Programms Evaluation Komplementärmedizin PEK (currently only available in German, but machine-translated here), and this brief summary is drawn largely from his account.

The Swiss authorities – both the government and the Federal Office of Health (BAG) – tried to sweep the PEK study under the carpet. A conference scheduled for April 2005 to present and discuss its results had to be cancelled because the Federal Office of Health prevented the publication of the study data. Some collaborators were even coerced into deleting all PEK-related data from their computers. The final meeting of the PEK international review board (six professors from Switzerland, Germany, Denmark and the UK responsible for the scientific quality of the study), scheduled for June 2005 for a final assessment of the project, was cancelled. (The review board eventually produced a summary report in September, which is highly critical of the political interference in the study.) Many contributors had their contracts terminated before their work could be completed. The recommendation in the final draft that homeopathy, anthroposophical medicine and herbal medicine should stay in the compulsory health insurance scheme was deleted in the final publication.

The Swiss government pre-emptively decided to exclude all CAM therapies from the compulsory health insurance scheme as of 30 June 2005, effectively ignoring not just the weight of scientific findings and economic benefits (which could save SFr millions on the health budget) which were emerging from the still-to-be-completed PEK study, but also the weight of Swiss public opinion.

In this context, the appearance of the Shang et al meta-analysis in The Lancet two months later – notably pre-empting the final report from the PEK international review board – can do little else but appear even more biased and reverse-engineered than it does already in its own right (see Myths and Misconceptions). A letter to The Lancet from the Swiss Association of Homeopathic Physicians raising objections to the study was not even granted publication.

None of this – aside from the initial frenzy surrounding the announcement of the conclusions of the meta-analysis on homeopathy – appears to have raised so much as a whisper from the English-speaking international media. Even in Switzerland it was only reported piecemeal so the full extent of what happened was not readily apparent.

Perhaps it’s worth noting that Switzerland is ranked as 8th most competitive nation in the 2005 World Competitiveness Yearbook. (In comparison, the UK came 22nd.) And it’s also ranked 8th in terms of the major exporting countries of chemical and pharmaceutical products. Around 5% of current global pharmaceutical R&D is attributable to Swiss companies. Just one of these companies, Roche Holding AG, parent company of Roche Pharmaceuticals, the manufacturers of the anti-viral drug Tamiflu, reported 2006 net income which was greater than the entire gross domestic product – that is, the value of all final goods and services produced within a nation in a given year – of the bottom 119 nations of the World Bank’s 183-nation rankings in 2005.

Since many university medical research laboratories would cease to exist without the support of the pharmaceutical industry, it’s perhaps no surprise that “at the end of 2004, professors of the medical faculties had expressed the intention at a meeting of the Swiss Academy of Medical Sciences … to do everything in their power to prevent complementary medicine remaining in the basic insurance. A dean voiced the prevailing opinion: “We must provide hand grenades [literal quotation, personal communication of a participant of that conference] against complementary medicine.”” (Dr med Peter Heusser).

Against the backdrop of more and more high-quality studies demonstrating the clinical effectiveness of homeopathy in practice, it will be interesting to see if The Lancet can recover its scientific credibility this time around, or whether this will turn out to be yet another ill-conceived attempt at a hatchet job jumping on the Colquhoun-Goldacre bandwagon.

“The prerequisite for today’s medical policy is naturally the currently predominant system of medicine. The sick are the source of income, therefore it is necessary for sick people to be there, yes, it proves advantageous if one makes the people artificially sick.”
Dr med Steintl: ‘International Medical Policy’, 1938, Berlin



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



Anti-nonscience

Sunday, March 25th, 2007

Cherry picking

“We have actually touched the Borderland where Matter and Force seem to merge into one another, the shadowy realm between the Known and Unknown … I venture to think that the greatest scientific problems of the future will find their solution in this Borderland, and even beyond; here, it seems to me, lie Ultimate Realities, subtle, far-reaching, wonderful.”
Sir William Crookes

Poor Professor David Colquhoun. He’s so caught up in his personal identification with what ‘science’ means to him that he’s driven to ever greater efforts in his attempts to excommunicate subjects like homeopathy from not just his own world view but everybody else’s as well.

He’s not alone, of course. But the more he and those like him rant and rave about what does or does not deserve to be given the status of card-carrying member of the ‘science’ club, the more they reveal the emotional foundation of their position, and the less the argument has anything to do with real science. His latest effort is an article in March 22nd’s Nature magazine entitled ‘Science degrees without the science‘ in which he lambasts British universities for offering science degrees in complementary medicine, judging this as “anti-science”.

Of course, the universities are just drawing their boundaries wide of Prof Colquhoun’s personal comfort zone, which has very little to do with the fundamental nature of rigorous scientific enquiry. (See the essay Unscientific Attachment for more on this subject.) The paradoxical thing about Colquhoun’s increasingly high profile position on the subject is that findings from disciplines likely well within the boundaries of his own definition of ‘science’ have already proved his thinking to be hopelessly flawed. (Not to mention that Jungian psychology also shows it to be highly self-reflective).

Many of the arguments put forward by complementary medicine’s detractors owe more to 19th century scientific reasoning than they do to the 21st century, and where they do make a valid observation, they usually fail to see that exactly the same mechanisms are at work in their own field.

80 years after Werner Heisenberg demonstrated that events do not possess an absolute deterministic predictability independent of the people who are ‘observing’ them, medical science continues to worship the gold standard of the randomised double blind clinically controlled trial for all the world as if it’s based on solid foundations instead of an invalid assumption and the type of linear logic that’s more appropriate to understanding machines than living systems. While being able to readily perceive the fundamental flaws in RCT methodology when applied to ‘unacceptable’ subjects, the same individuals appear totally blind to the same flaws operating within the bounds of what they view as ‘acceptable’. Trumpeting that ‘belief’ plays a large part in complementary medicine’s effectiveness, they miss the fact that exactly the same process is operating in conventional medicine, and with far greater strength at that. Instead of taking the intelligent scientific view that such phenomena need to be properly investigated, tested and incorporated into our understanding of the processes at work, they simply let the evidence feed their unthinking prejudice.

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

What’s more, that tired old chestnut that dilutions which contain no trace of material substance cannot possibly produce any result

” … 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)

Landmark achievements in scientific enquiry owe most to individuals who have been able to step outside the prejudices of their conditioning and perceive natural processes in a fresh light without attachment to underlying assumptions. If anyone is “anti-science”, it’s those who cling noisily and somewhat desperately to the sacred cows populating their maps of the world, behaving exactly as one would expect from people who have projected their own individual sense of identity onto their chosen occupation and who experience some kind of personal affront when faced with a challenge to what they perceive as that occupation’s fixed consensus view of the world. (In reality, no such consensus exists and what is generally held to be ‘true’ by any majority of the individuals involved is constantly changing and evolving.) People like Prof Colquhoun seem to feel that the solution to the problem is not to rise to the challenge but to try to bully everyone else into ignoring it or rejecting it in the hopes that it’ll go away. Unfortunately, life just isn’t like that and truth has a way of coming to light regardless.

Interviewed by Nature magazine for an accompanying news item on the subject of university degrees in complementary medicine, Ben Goldacre, a London-based medical doctor, journalist and frequent critic of homeopathy, says. “I can only imagine that they teach that it’s OK to cherry-pick evidence. That’s totally unacceptable.” Indeed it is. But it seems that both Dr Goldacre and Prof Colquhoun are no mean cherry-pickers themselves. Didn’t their mothers teach them to check themselves in the mirror before venturing out into the big bad world?

“All great truths begin as blasphemies.”
George Bernard Shaw



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