Facilitated Communication for 23-Year Coma Man?

In the newspaper yesterday, it was a heart-rending story. A man lies in a coma for 23 years, until a brain scan reveals he is actually conscious after all, and has been all that time. He is given a keyboard, and wow! He can tell us all about his thoughts and feelings, and how he coped throughout his long imprisonment, trapped inside his own body.

On TV last night, it looked like something else. Rom Houben was not exactly typing out his own messages. They were being typed by a "helper" who was holding his hand and carefully aiming his index finger at a flat touchscreen. He did not appear to be even looking at the screen (as you can clearly see in these pictures from the BBC & Guardian), yet he typed with amazing speed and accuracy. Now read this extract from the Facilitated Communication (FC) page at the Skeptic's Dictionary:

FC clients routinely use a flat board or keyboard, over which the facilitator holds their pointing finger. Even the most expert typist could not routinely hit correct letters without some reference as a starting point. (Try looking away from your keyboard and typing a sentence using just one finger held in the air above the keyboard.) Facilitators routinely look at the keyboard; clients do not. The messages' basic coherence indicates that they most probably are produced by someone who is looking at the keyboard.

The resemblance is uncanny, is it not? Needless to say, FC is complete bollocks. It is easy to test: show the patient some stimulus or other with the facilitator absent, then bring them back in and ask what it was. If they can only "see" what the facilitator has seen, it is not communication. Has this been done for Coma Man? None of the stories I have read seem to have mentioned this possibility. Are we being taken for a ride?

I will expand this post later if I have time to find the full article...

UPDATE: I have found the journal article mentioned in the news stories above. It's open access and can be read here. It's an interesting study of 103 patients, comparing different diagnosis methods. It doesn't include any details of individual cases but it does say that the main indicator of consciousness was "purposeful eye movements" rather than the foot tapping mentioned in the Grauniad article. This paper clearly isn't the source of the story. More digging needed...

UPDATE 2: Now the mighty Randi is on the case. He seems pretty sure it's a cruel farce. PZ Myers is sceptical too, but it also looks like the story is proving popular with right-wing yanks keen to restart the Terri Schiavo debate. I smell a rat. I smell a giant rat...

UPDATE 3 (Wednesday): Now it's getting ridiculous. The Grauniad today has a full page on the case, again without a single sceptical word. There is more detail of the foot movements mentioned in the earlier article, but it stinks!

Nicolaes (Rom's mother) recalled: "We needed to make him press the mouse. But how? He was lying down. He's very spastic. He can't control his movements. The doctor saw that he was moving his right foot. We put the mouse under the foot and were shouting, 'Push, Rom, push, Rom, push.' And he pushed. The computer said 'I am Rom'."

This is just plain daft. He goes in one second from barely being able to move, to being able to type a coherent sentence with one "spastic" foot? Clearly the computer must have been pre-programmed to say "I am Rom" on a single click. I could shove a mouse under my dog's paw and get the same effect!

The Science of Homeopathy

"I'm going to explain to you exactly actually how it works..."

You may have already seen this video when it first did the rounds a few months ago, giving everyone a good laugh. Now it seems that someone is trying to get it taken off the internet, with the entirely predictable result that hundreds of bloggers are now posting it all over again. Poor Dr Charlene Werner is rather embarrassed by all this attention. Good! This is as dense a pile of teh stoopid as you are ever likely to encounter! Enjoy...

Racism, Celebrities and the Poo Bin Mystery

I have been a dog owner for a few years now, and like all good owners I always pick up my mutt's crap and bin it. At first, this usually meant just lifting the lid of the poo bin and dropping the bag inside, but soon I began to notice that the bins round my way were gradually being replaced by bigger, chunkier receptacles with a lock on the front and a big metal flap on the lid. You lift the lid and place the bag on the flap, then when you close the lid the poo drops inside. To retrieve it, should you be minded to do such a thing, you would need the key to unlock the front. Why? What is the point of that? I began to wonder, is dog poo valuable? Is there a thriving market in dogshit derivatives? Is the borough council trying to corner the market in a precious commodity here? What are my hound's mounds worth?

I have been thinking about racism a lot this week. I went to Bolton v Tottenham last Saturday, with some old mates from London who follow the Spurs all over the country. They told me about their Sol Campbell song: a ditty so vile and so offensive that it has finally been officially outlawed by the club after years of complaints and hypocritical tabloid outrage. Anyone caught singing it nowadays is immediately ejected from the ground and may be banned for life. Undaunted, the crowds now simply hum the tune instead. "Dum dum dum-de dum-de dum..." they go, and everyone knows exactly what it means: "Sol, Sol, wherever you may be, you're on the verge of lunacy, and we won't give a fuck when you're hanging from a tree, Judas cunt with HIV". Nice. My view is that this is an incontrovertibly racist song. That may not be the intent (my friends were quick to deny it and you don't have to look far on the net to find convoluted self-justifications) but you simply cannot sing "hanging from a tree" to a black man without evoking the spectre of lynching. To argue otherwise takes a special kind of stubborn stupidity, a wilful refusal to step outside your own narrow worldview, and I expect better from Spurs fans who endure hissing and similarly obnoxious songs about "gassing the Jews".

Then Bruce Forsyth did something similar, defending dimwit nonebrity Anton du Beke for his you-look-like-a-Paki "joke". Can Brucie really be so dim or so divorced from reality that he really thinks "Paki" is no worse than "Limey" as an insult? Maybe in Brucieworld it isn't, but has he ever tried to imagine what it feels like to suffer that kind of abuse? Was he ever spat at or insulted in the street, or his kids beaten up for being "Limeys"? I don't think so. And if that scandal wasn't bad enough for the BBC, it then turned out that they featured the BNP on Radio 1's Newsbeat show last week, giving a platform for two racist morons (introduced as simply "young guys who are BNP members.. ..Joey and Mark", but who were actually Joey Smith, managing director of the BNP's record label, and Mark Collett, BNP Director of Publicity) to tell millions of listeners that London-born footballer Ashley Cole "came to this country" and will never be "ethnically British". And all this is in advance of Question Time next week, at which head nazi Nick Griffin will be presented as a democratic party leader. I have no doubt that Griffin will keep his nastier racist thoughts well-hidden on this show, and that the BNP will gain enormously from the coverage, however well his opponents perform.

The BBC used to make far better programmes about the BNP. In 2003 they gave a camera to Andy Sykes, a former BNP member in Bradford who had seen the light and decided to expose the truth about his erstwhile colleagues. Was it true, as Griffin claimed, that the BNP had modernised, become more professional, moved away from its racist past? No. Sykes's undercover filming for Panorama revealed them (surprise surprise) to be knuckledragging thugs just like their NF skinhead predecessors of the 70s (sadly, the film has disappeared from Google video, although there is more Panorama material about the BNP here). At one point in the film, a group are meeting in somebody's house when they are joined by a late arrival, who boasts proudly that on the way to the meeting he has emptied the dog poo bin at the top of the road and posted the bags through the letterboxes of Asian families along the street. What larks! And what a eureka moment for me! Could this be the answer to my poo bin mystery? Is this why the boxes now have to be locked up as tightly as the night safe at the bank, to stop racist scumbags using the contents to terrorise their neighbours? I don't know for sure, but to this day I have never again picked up a dogturd without thinking of the BNP. This, Brucie and Anton and Spurs fans, is why you should never joke about "Pakis" or black men "hanging from trees". Whatever your intentions, it makes you part of a culture of racist violence and oppression.

Who knows, maybe there is another explanation for the Fort Knox poo bins, but it is something to think about if you watch Griffin on the box next week. Every time you see his smug, pudgy, lopsided face, imagine a hand inside a pale brown plastic bag coming down on a huge pile of steaming, squidgy, stinking shite.

A Very Hard Easy Probability Question

Here is a question I set my students today. It is, mathematically speaking, very easy. It can be solved using mental arithmetic, and requires no complicated formulae or advanced concepts at all. It is not a trick question. However, people always find it incredibly difficult to get right, and many people fail to understand the solution once it has been explained to them. I have had vitriolic arguments with distinguished colleagues who refuse to accept my reasoning. What do you think? I will post my answer in a day or two, but in the meantime let's hear some suggestions...

The question is this. Imagine you have been tested in a large-scale screening programme for a disease known to affect one person in a hundred. The test is 90% accurate, and you test positive. What is the probability that you have the disease?

Understanding this kind of question is very important, because it leads to exactly the dilemma you might face if you were screened for a major killer like breast cancer or testicular cancer, and tested positive. Should you immediately opt for a risky procedure to investigate further, or would that be to submit yourself to unnecessary surgery? Gerd Gigerenzer wrote the book Reckoning With Risk about this kind of problem (it's a brilliant book too, so read it if you can), concluding that thousands of people are facing unnecessary dangers because of poor understanding of probability. Over to you...

Happy New Year!

New academic year, that is. By 'eck, it's been a busy, wet summer. I really feel like I need a holiday, but instead here come hundreds of new students. Welcome to Preston, guys! Here's a few bits and pieces to start with...

I'm doing 10:10. Are you? Follow the link, and pledge to reduce your carbon footprint by 10% in 2010. Also, while I am in campaigning mode, watch THIS FILM too. Good, isn't it?

Now, if that was a bit serious for you, check out this beautiful model pig. I love the customer reviews underneath! If it was just a bit cheaper I would definitely buy one.

What else is new in the world of quack (or should that be "oink") medicine? Following a campaign by Sense About Science, the WHO declared that homeopathy should NOT be used to treat HIV, TB, malaria, influenza or infant diarrhoea. Wahey! This is perfectly sensible advice, of course, since homeopathy is completely useless for all these conditions (as it is for all conditions, in fact), but it is still nice to see the WHO taking a stand. The reaction of the homeopaths has been predictable: the usual bluster, whining and cherry-picking of evidence. When will we be rid of these murderous imbeciles? Homeopathy is dead, dead, dead, but the corpse just keeps on twitching.

Meanwhile, Simon Singh's libel case against the back-crack quacks rumbles on, but legal blogger Jack of Kent has decided to take a sabbatical from blogging! How will I keep up now? I hope this does not mean I have to swallow my pride and join the infernal tweety thing.

I have been ill myself for the past couple of weeks, but there is one complementary medicine I do approve of and sure enough, a few doses of uisge beatha have made me feel a lot better (I like to use it in conjunction with a few crystals of dihydrogen monoxide, to enhance the effect). My trip to the Rebellion festival was probably the cause of my malady: I am really too old now for a four-day bender of alcohol, junk food, late nights and serious mayhem. Not that it will stop me going again next year! Here are a couple of highlights - the Exploited and the UK Subs. See what you missed?

Oh Noes, What Have I Done???

I'm off to Rebellion in a bit, but first I thought it was time to rediscover the past. I had many punky hairstyles back in the day, but I have been a bit sensible lately. Enough! So I went down to Boots looking for L'Oreal Super Blonde, which is what we always used for that platinum peroxide Billy Idol look, which is cool on its own or is a great base for brighter colours. I ended up with L'Oreal Blonde Supreme, which sounds similar, doesn't it? Eh? Maybe not!

Here's me before, during and after...





























That's not Billy Idol! I'm flamin GINGER! Aaargghh!
Oh well, it still takes a bit of colour OK. Blackpool here I come...

UCLAN CAM Review - Full Report

---

UPDATE: July 15. The report of the UCLAN working party review of complementary medicine, as approved by the Academic Board last Thursday, has now been published. For the moment it is only on the staff intranet but I assume it will be public soon. UCLAN staff can find it at https://staff.uclan.ac.uk/9930.htm

UPDATE: July 17. David Colquhoun has now posted the full report and his own analysis of its conclusions.

---

Here is my section-by-section commentary on the report of the UCLAN working party review of complementary medicine.

Section 1: Introduction

The review is framed as a response to "concerns expressed by some colleagues within the University" but it never explains what those concerns were/are. I would have liked to have seen responses to my seven specific complaints, which I set out here exactly as they were submitted to the review team.

1. Homeopathy is nonsense. There is no reason to think it could work. There is no good evidence that it works better than placebo for any condition. There is plenty of evidence that it does not work. To teach otherwise is to lie to our students, and to train them to lie to their patients.

2. Homeopathy is not science. It is not even non-science, it is anti-science because its laws contradict the dose-response relationship and ignore the Avogadro limit. It invokes a mystical energy known as the “life force” which cannot be detected scientifically. Its advocates disparage the scientific method and ignore or distort the results of scientific analysis.

3. Homeopaths have been caught out many times giving dangerous advice, promoting worthless remedies, claiming to be able to prevent serious diseases, disparaging scientific medicine and so putting patients at risk of serious harm or even death. Are UCLAN homeopaths guilty of this? If they are not, why are they so secretive about what they teach?

4. The Society of Homeopaths is not a fit body to participate in degree validations. UCLAN should have no dealings at all with a body which fails to enforce its code of conduct when members give dangerous advice, and which resorts to legal threats when criticised for this.

5. Chinese herbal medicines are complex mixtures of substances, few of which have been tested for safety or efficacy, and which may carry significant risks of harm. It is unethical for anyone at UCLAN to be involved in giving Chinese herbal preparations to patients until they have been properly assessed for safety and effectiveness.

6. Acupuncture may have some effects but they are certainly small (at best) and have nothing to do with Qi, meridians, yin & yang or non-existent “organs”. Such notions are unscientific and should not be taught as science. The same applies to many other nonsensical forms of CAM which UCLAN and associated colleges promote, including Bach flower remedies, cupping, moxibustion, auriculotherapy, therapeutic touch and astrological medicine.

7. Proper scientific testing of CAM is certainly possible if researchers are properly trained in the scientific method, but UCLAN’s CAM courses appear to contain virtually nothing about research design or statistics. Where there is genuine science content, it is often directly contradicted by the CAM content. This is unacceptable.

Nevertheless, I am delighted that UCLAN did take my complaints seriously, and I welcome this report. As you will see below, some of my points have been addressed, but some are still outstanding.

Section 2: Context

This short section mentions the "wider debate and controversies" around CAM, but again does not mention any specific examples. I would have like them to acknowledge the sterling efforts of David Colquhoun, for example, to force the disclosure of teaching materials, and the resulting embarassment when it was revealed that Westminter's CAM students are being told things like "Amethysts emit high yin energy" (UPDATE: July 17. DC has now posted a copy of the evidence he submitted to the review committee). Instead, the debate is described in rather dry fashion as relating to four themes: evidence/efficacy of CAM, suitability of CAMs as topics for university courses, the nomenclature of CAM degrees (specifically whether they should be called science), and the ethical/economic impact of CAM upon society as a whole.

Section 3: Method

The report explains that the review included a literature review (a list of papers is included later on, showing that some poor sod actually read much of Lionel Milgrom's epic series of inane quantum metaphor papers, which feat surely deserves a medal), some commisioned reports (which I would very much like to know more about), the preparation of a paper on the ethics of CAM by one of the reviewers (which I will also try to obtain), face-to-face meetings with interested parties (me included) and written evidence from a variety of individuals and groups.

Section 4: Consideration of Themes

Now we get to the meaty stuff! Each of the themes identified in section 2 is taken up in turn.

Section 4.1: Efficacy

Disappointingly, the reviewers decided that efficacy was outside their remit, due to the "volume and diversity of views". I think this was a mistake, since it undermines all their later comments about the importance of patient autonomy, which is only possible when patients are given adequate information on which to base their decisions.

Section 4.2: The Role of Universities in Society

I found this section unbearably waffly. There are lots of worthy statements about the importance of "critical thinking" but with no specific examples of what this means in practice it is impossible to say whether CAM students really develop these skills. There are lots of vague claims about the importance of "diversity" and of students being exposed to challenging ideas and debates, but, having ducked the efficacy question, there is no acknowledgement that some ideas have been completely discredited. Would the team argue that astronomy students must be taught astrology? Biologists, creationism? Would they really benefit from such "diversity"?

Somehow, this conclusion leads to the first recommendation in the report: that UCLAN should provide some postgraduate research scholarships to "suitably qualified" staff and students, with multidisciplinary supervisory teams, to "facilitate development of a broad range of research skills" and "contribute to the generation of knowledge in CAM". Fair enough, I suppose, although it would seem very unfair if scarce resources were diverted into CAM at the expense of other disciplines. There are certainly some CAMs where more research would be useful (if it is of high enough quality) and I would be happy to help develop these projects. I would draw the line at homeopathy, however, which has already been studied in quite enough detail to know that it is useless. Ho hum.

Section 4.3: Nomenclature.

Not much to argue with here! I do accept that defining "science" can be tricky, and that disciplines differ widely in exactly how "Sc" a BSc or MSc should be. My big problem with CAM degrees is that they are often antiscience, not just non-science, so I am very pleased with the recommendations here: that CAM degrees should be simply named "Bachelor with Honours in X" and called B (Hons) rather than BSc (Hons); and that there should be increased multidisciplinary input to CAM teaching so as to "facilitate greater exposure to subject expertise and different paradigms".

Section 4.4: Ethics

This is another somewhat waffly section, which takes two pages to explain that if you ignore the question of efficacy, there is no ethical reason not to teach CAM. However, the reviewers do note the need for patients to be protected from "lack of professional regulation, poor product quality assurance and inadequately trained practitioners". They therefore recommend that UCLAN should refrain from offering any CAM courses "until such disciplines have achieved statutory regulation status".

There are different ways of looking at this. One could say it is just passing the buck. It could also been seen as circular, since one major aspect of regulation is training of practitioners. Alternatively, one could look at the current level of disarray among CAMs regarding regulation: the dismal failure of the CNHC to attract members in any number (only a few massage therapists have joined so far) and the current implosion of the General Chiropractic Council following the ill-advised attack on Simon Singh, and conclude that most CAMs will never get their act together to meet the necessary standards.

Could this be the end of CAM courses at UCLAN? Watch this space...

The Ancient Wisdom of the East

Enthusiasts for alternative medicine always seem to stress how old their ideas are, as if "traditional" medicine was a good thing. They also love to denigrate "Western" medicine (even homeopaths do this, and their particular quackery was invented by a German). I have never understood why Eastern traditions are held in such regard in this context. Would you really want medical care from someone who does not accept germ theory, or who doesn't know that blood circulates around the body? Yet people still shell out a fortune for Traditional Chinese Medicine (TCM), despite the fact that there is bugger-all evidence it actually works. Most of these people - indeed, most customers for all types of CAM - are wealthy, educated women who really should know better. But what they are buying is a strangely sanitised version of the real thing, an airbrushed, bowdlerised, Disneyfied tradition with one missing ingredient. Animals! So here are two stories from this week that show just how wise and wonderful the real Eastern medicine can be.

Huyet Linh

The first article was in Private Eye's "Funny Old World" column (Eye 1239), having originally appeared in The Vietnam Nation back in February. It describes the work of the men who hunt "huyet linh", a Vietnamese folk remedy that...

"...is believed by many people in the northern mountain provinces to have medicinal properties. They often use it in the belief that it strengthens the health of pregnant women, facilitates childbirth and prevents post-natal diseases."

Men too take huyet linh, to boost their sexual health and give them increased stamina. To find it, our hunters embark on dangerous expeditions into the deep jungle of Thung mountain. They live for days in caves, sleeping wrapped in leaves to hide their human scent, eating only dried food and risking death or injury clambering through the rocks and trees.


The men are following a troop of monkeys, looking for females of child-bearing age, yet it is not the monkeys themselves that they are interested in. It is something the monkeys leave behind...

"After three days of walking along bumpy, snaking paths, and climbing up and down slippery caves, Voong looks a decade older than his actual age. His arms, legs and faces are covered with bruises and scratches. However, he blossoms into a smile of contentment when looking at his indigo haversack full of pieces of blotting paper darkened with monkey menstrual fluid."

Yes folks, it's monkey blood! The hunters earn millions of dong collecting drops and clots left behind by menstruating females. Mmmmm, dig that crazy oriental wisdom! Still, at least the monkeys are unharmed by this particular quackery. Another Asian forest animal is not so lucky.

Slow Loris

The slow lorises of Indonesia are an endangered species, mostly because they are illegally caught and sold as pets. In Japan, a slow loris will set you back at least $1,500 (according to a BBC report from 2007)...

"The pet shops advertise them, and they're very popular to Japanese ladies," says Masayuki Sakamoto from the Japan Wildlife Conservation Society. They're easy to keep, they don't cry, they're small, and just very cute."

They are also the planet's only poisonous primate. Incredibly, they store their poison in their elbows, which they then suck in order to inflict a toxic bite. For this reason, pet lorises have often had their teeth ripped out by the unscrupulous traders. This is cruel, of course, and also means that the lorises might find it much harder to survive if they were rescued and returned to the wild. Animal rescue charities are now studying their toothless lorises to work out how badly it affects them.

Pet traders are not the only enemy, however, for it turns out that lorises are also prized for their (you guessed it) medicinal and spiritual properties. That brings me to my second Eastern wisdom story this week: today's Grauniad report that...

"...luckless lorises frequently find themselves roasted alive over wood fires while eager people catch the supposedly life-giving liquor that drips out. Bits of their bodies are used in traditional medicine. And legend has it that villagers anxious about traffic safety need only bury a loris beneath a new road to keep it free from accidents"

The Grauniad is coy about what the benefits of loris juice are supposed to be, but a quick web search found this on the Care for the Wild International website:

Use in Traditional Medicine

Almost all body parts of slow lorises are used in Traditional Chinese and Khmer Medicine in Cambodia, China, Lao PDR, and Vietnam; to a lesser extent also in India and Indonesia. Use of:

Fur: in Traditional Asian Medicine believed to support wound healing; in Indonesia locally worn as amulet to ward off danger.

Eye-balls: as love potion

Flesh: to cure epilepsy

Meat: to cure stomach ailments or asthma

Whole body: in alcohol: used as “energy drink”

In Britain, mainstream providers of TCM tend not to go for the whole tiger-penis rhino-horn monkey-period nonsense. For example, my friends at the Northern College of Acupuncture are keen to stress that they do not use any endangered animals. But if ancient oriental wisdom can be so obviously, ridiculously moronic when it comes to rare animals, why would anyone credit it when it comes to more mundane ingredients? The whole thing stinks of economic expediency. They know that their market consists of air-headed muppets who would run a mile if they thought anything cute and fluffy was getting the chop on their behalf. Pathetic! Take a look at this loris, hippies. This poor wee fucker is the true face of your ancient Eastern wisdom.

Tonight's Star Prize: A Blow On The Head!

Last week I found myself in the Talisker distillery on the Isle of Skye, where I noticed an old book in one of the display cases in the visitor centre. It was A Description of the Western Isles of Scotland, published in 1703 by a local man named Martin Martin. According to the accompanying panel (shown below), the book is a naive record of island fables: "a fat pudding thrown into the sea calms the waves", "the huge King of Herrings leads the shoals" and so on. Best of all, it describes a blacksmith who "cures Faintness of the Spirits by laying the patient's head on an anvil and smiting it a mighty blow within an inch of the sufferer's ear".

This made me laugh because I had just read some articles via Bad Science about a modern equivalent, the hilarious Kadir-Buxton Method (I won't describe it here, just visit the great man's own site for the lowdown). It turns out K-B is a serial crank who also has some bizarre ideas about free energy and climate change, but at least he was original. Or so I thought! Now it looked like the Skye smithy got there three hundred years earlier.



I looked up Martin Martin on the net and found that his book is something of a classic. It stayed in print for over a century and has been revived several times since then, including a special anniversary edition in 2003. Maybe K-B had read it, and nicked the idea? No, the truth is odder still...

The full text of A Description of the Western Isles of Scotland is now available online, so I was able to track down the original passage in chapter 10. This is what Martin Martin actually said:

There is a smith in the parish of Kilmartin, who is reckoned a doctor for curing faintness of the spirits. This he performs in the following manner:

The patient being laid on the anvil with his face uppermost, the smith takes a big hammer in both his hands, and making his face all grimace, he approaches his patient; and then drawing his hammer from the ground, as if he designed to hit him with his full strength on the forehead, he ends in a feint, else he would be sure to cure the patient of all diseases; but the smith being accustomed to the performance, has a dexterity of managing his hammer with discretion; though at the same time he must do it so as to strike terror in the patient; and this, they say, has always the designed effect.

This is nothing like the description in the Talisker display! The smith does NOT strike a mighty blow, and Martin is not naively reporting that it works. The smith merely pretends, in order to give his patient a shock. Of course he doesn't actually hit the patient. This is so obvious to Martin that he can joke about it, saying that a real blow would certainly cure all diseases - ie by killing the patient. And there's a refreshing note of scepticism in the way Martin makes clear that he doesn't necessarily believe the stories: the smith is "reckoned" a doctor, the treatment "they say" has the designed effect. OK, by modern standards Martin Martin comes over as a fairly credulous witness, especially in the later chapter he devotes to Second Sight, but on this he is pretty sound. What would he have made of "Inventive Andy" Kadir-Buxton and his Method? I think he would have laughed his sporran off.

PS: The 18 year-old Talisker is pretty bloody gorgeous!

Back-Crack Quacks Sell BOGUS Treatments

Anyone who goes to a chiropractor needs their head examined. OK, there is weak evidence that it is effective (ie better than nothing) for some lower-back problems, but it is no better than other treatments (eg painkillers and gentle exercise) and carries significant risks. Chiropractors use "high velocity, low amplitude thrusts" (in other words, they smack you in the spine) to correct spinal abnormalities called subluxations which exist only in their imaginations. This is highly dangerous, of course, and many patients have suffered chiropractic strokes in which the manipulation has interfered with blood flow to the brain, leaving the victims brain-damaged or even dead. Some chiropractors do this without obtaining proper consent, since they believe it works better if the patient is not expecting it. They also do it to young children. If that wasn't bad enough, they also carry out these assaults on people who have nothing wrong with their backs at all. Why? This is where chiropractors step out of the world of reason, into the realm of purest quackery. They have decided, without any scientific justification at all, that dozens of different ailments, unrelated to the spine, can be treated by their back-cracking.

Respected science writer Simon Singh explained this in a Guardian article as follows:

You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

I can confidently label these treatments as bogus because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

Naturally, the BCA responded to this, but like other charlatans before them (homeopaths v The Quackometer, herbalists v David Colquhoun, vitamin quacks v Ben Goldacre), they ran to their lawyers to try to silence the critic rather than address the criticisms. They sued Simon Singh for libel. What a stupid move! Singh was obviously, absolutely correct in what he wrote. Surely he would win easily? But no, this is England. We have the stupidest libel laws in the world. And, in Justice David Eady, we have one of the stupidest judges...

Eady's ruling this week hinged on the exact meaning of the word "bogus". He decided that Singh's use of the word meant that he was saying the BCA were knowingly and dishonestly promoting useless treatments. This goes far beyond most common usages of the word (as explained by the mighty Language Log) to mean useless, false, incorrect, unbelievable or silly. It ignores the fact that Singh's second paragraph explained exactly what he meant by "bogus". It means Singh now has a difficult decision to make, for this extreme meaning will be very difficult to prove in court. He could decide to appeal against the judge's ruling. He could even end up in the European Court of Human Rights, defending his freedom to express his opinion, but this would be hugely expensive and risky. He may have to settle. Whatever he does, all sensible people should support him in any way we can.

If there are really any chiropractors out there who genuinely believe you can cure ear infections, asthma etc, you are idiots. If you badger people into unnecessary, expensive and never-ending preventative treatments, you are unscrupulous idiots. If you play on your patients' fears to try to get them to bring you their children, you are total bastards.

Chiropractic is bogus. Bogus. BOGUS!

Homeopathy Is Antiscience (Part 2)

"Who you gonna believe, me or your own eyes?" - Chico Marx

In the first post in this series I argued that homeopathy has a very low probability of effectiveness, because it ignores the Avogadro limit, it contradicts the dose-response relationship, and it uses "remedies" so ridiculous they are beyond satire. However, this does not mean that homeopathy is impossible: a low a priori probability could still, in theory, be nudged upwards by the accumulation of sufficiently convincing evidence. Using Bayesian mathematics, the probability can be recalculated after each study, giving a new prior probability for the next study which will be higher after a positive result and lower after a negative result. Eventually, given enough evidence, the prior probability could become high enough that even the most hardened sceptic would be forced to acknowledge the reality of the phenomenon. Think of Newton struggling with his theory of gravitation: he hated the idea of action at a distance, that one body could influence another instantaneously across empty space, yet the exquisite precision of his calculations gradually forced him to accept that it was indeed possible. So let's try to apply the same wisdom to homeopathy. Just how strong is the evidence?

The evidence for homeopathy can be grouped into four categories: in increasing order of credibility, these are individual reports, customer satisfaction surveys, experimental studies and meta-analyses. Of these, the first two are not generally considered very convincing, for several important reasons that will be explained. Let's start with individual reports...

Individual reports (aka anecdotes)

It is very easy to find individual accounts of the power of homeopathy. Pro-homeopathy sites are plastered with testimonials, such as this incredible story from classical homeopath George Vithoulkas:

A case in a coma for three months after an aorta transplant and a rejection process

The doctors became desperate.. ..the man had one or two days to live.. ..homeopathy could do something for the old man.. ..suspend all allopathic medication.. ..in seven days his consciousness returned and in twelve days from the beginning of the homeopathic treatment he asked us to take him home and we did.. ..one month later the man was so well that the only thing that was left was a swelling of his ankles.

Virtually every sceptical article attracts dozens of responses describing how homeopathy had miraculous effects for this or that illness, written by homeopaths and by homeopathy users. They range from the mundane to the incredible. Here's a mundane one that appeared this week on DC's Improbable Science:

My hayfever was so bad before I started taking pollen that I could at times be practically unconscious. I could never go for a walk in the park without first being dosed up with massive amounts anti-histamine. When I first bought the homeopathic remedy I knew nothing about medicine; I simply bought it because I was having an attack and couldn’t get any anti-histamine. I remember wondering how something that made me ill would make me better, but as I had no alternative I bought it and it helped.. .. I can now go out walking in the park now without any anti-histamine. I would definitely say that was a cure.

Here's another recent one, from a Guardian CIF thread:

I went to the Royal Homeopathic Hospital yesterday on referral from my GP. I've never been in a more welcoming and clean hospital. My God they actually had plants in pots there unlike the sterile NHS wars where any natural life is deemed a potential health hazard (by evidence-based standards of course).

I spoke to a homeopathic doctor (who was medically trained as well) and we went into the reasons why homeopathy is so attacked by the establishment. It's really sad to see that it is ignorance and big business conspiring, and they face a threat of having funding taken away.

I got more out of that visit than several visits to my GPs, who barely had time to speak to me and could only offer me a steroid spray or inhaler for my wheezing cough. They even tried to prevent me from my right to be referred to a homeopathist. They failed. Long may homeopathy and alternative healing that springs from a verifiable methodology continue.

People who post such stories seem genuinely surprised that their readers are not immediately converted to the homeopathic cause. To them, their experience feels so powerful that it trumps any scientific study: they simply "know" it works. They seem to regard any expression of scepticism as an accusation that they are lying, or as evidence that the sceptic is just part of a Big Pharma conspiracy (this attitude was beautifully spoofed in The Onion). In fact, most sceptics (myself included) are happy to accept that the vast majority of CAM users are genuine people who really believe their chosen therapies work. Even among practitioners there are probably many honest, kindly people: not every homeopath is a venal, lying con-artist.

The problem is this: there are many, many ways by which people can come to believe that a CAM treatment provides a benefit. Sceptics reject anecdotes simply because these other ways are all far more probable explanations for the benefit than the idea that improbable therapies like homeopathy actually work. It is worth spelling this out in detail because so many people fail to grasp this point. Let's have a look at the possibilities...

Why bogus therapies often seem to work

The list that follows is largely based on the late Barry Beyerstein's famous article Why Bogus Therapies Often Seem to Work, which everybody should read. My version adds a couple more points and unpacks the placebo effect to make 12 different explanations. If you can think of any more, please let me know and I will add them to the list.

1. The patient was not really ill in the first place. Many CAMs are simply providing reassurance for the worried well.



2. The illness was time-limited, so the patient would have recovered anyway. Colds, as the old joke has it, normally last a week, but with the right treatment can be cured in as little as seven days.



3. Because the patient has been feeling ill, they have taken time off work and cut down on their other activities. This rest has helped them recover.
   



4. The original diagnosis was wrong. The apparently intractable condition that has been "cured" was actually a less serious, time-limited illness.



5. The illness is episodic or cyclical, so if the patient usually takes their CAM when it is at its worst, the CAM will appear to work because of regression to the mean.



6. CAM therapists may encourage patients to change other lifestyle factors such as eating better, exercising more, sleeping more, drinking less and so on, and it may be these factors that make the difference.



7. Patients may take a range of treatments, including conventional ones, but attribute any improvement to the CAM. There is a nice example of this in John Diamond's book Snake Oil, in which a woman tells him that Gerson therapy has cured her cancer. On being pressed for more details, she admits that she has had chemotherapy too, but is convinced that it was the Gerson regime (carrot juice and coffee enemas) that made the difference.



8. Maybe talking to a therapist has improved their mood, so that they feel more positive about their condition. In this view, CAM is really just a branch of counselling. CAM consultations often last an hour or more, and involve talking about all aspects of the patient's life. It is not surprising that this can help people feel better.



9. There is an unconscious, conditioned placebo effect: they experience a learned response to the rituals of treatment. There is a good chapter on this in Barker Bausell's book Snake Oil Science, in which he describes experimental studies on animals and humans, showing that (for example) mice given repeated injections of an immunosuppressant continue to show the same suppression even after the injections are changed to a saline placebo.
   



10. There is an unconscious, evolved placebo effect. In Dylan Evans's book Placebo he argues that pain and inflammation after injury serve an adaptive purpose, to encourage us to immobilise the injury site, and to seek help. Once this "acute phase response" has done its job, the pain and inflammation are no longer needed and can decline.
    


11. There is a conscious placebo effect: they believe they will improve so they do. This effect of belief is what most people mean when they talk about "the placebo effect", and it is a wonderful thing that should be studied in more detail. Ben Goldacre's Bad Science explains that oval placebos work better than round ones, two placebos work better than one, coloured placebos work better than white ones, branded placebos work better than those in plain packaging and so on.
    



12. There is an investment effect: people who have given up time and money for a treatment are highly motivated for it to work, and so convince themselves that it has. The power of this effect is generally underappreciated, but is well-known to psychologists. For example, in this classic paper by Edward Desi, among students carrying out a tedious task for either a large reward or a small one, it was found that the ones getting the smaller reward reported having enjoyed the task more.
    

So when a sceptic dismisses an anecdote, they are not merely being stubborn or short-sighted. They are thinking about all these possibilities, comparing the probabilities, and applying Occam's Razor.

In the next post I will look at the next type of evidence: customer satisfaction surveys.

Calling All Punks!

Blackpool Rebellion this year is shaping up to be a snorter. The latest addition is Killing Joke, who will headline on the Sunday night. Fantastic! I first saw them at Hammersmith Palais in about 1981, around the time of their second album What's THIS For?, and it was one of the best gigs I've ever been to. At the time it was widely rumoured that the Joke deliberately booked the most inappropriate support acts, to drive the crowd into an angry frenzy before they came on. Sure enough, first band up were fey popsters Aztec Camera, whose sensitive acoustic opener provoked a storm of gobbing. They stuck at it manfully for a few songs but soon gave up, as the thick strings of plegm dripped from Roddy Frame's guitar and the chanting (off! off! off!) drowned them out. Next up were proto-goths UK Decay, whose schtick was whirling studded belts above their heads. Ignorant of this, my belts had been taken off me by the bouncers at the door, but fans in the know had kept theirs under their clothes until this moment and greeted UK Decay like a swarm of demented helicopters, a whirling mass of leather and steel. By the time the Joke played we were all so fired up it could never be anything but brilliant: the pounding drums, the shrieking vocals, the palpable anger. And to cap it off, a ruck on the way out trying to get our belts back. What a night! I've seen them again a few times since, most recently at the Mill here in Preston in 2003, and they've never disappointed: Jaz Coleman seems to get angrier with age. For them to be headlining the final night at Rebellion is pretty fucking exciting. It's a great way to end the festival.

Other must-sees at Blackpool include local boys One Way System, whose festival-closing set at Rebellion 2007 was probably the highlight of the weekend. The other contenders for that honour, English Dogs, are also playing again. They've given up on their cheesy thrash metal phase and gone back to early-eighties classics like Psycho Killer and Max The Millionaire. At Rebellion 2007 they handed out dozens of assorted hats before Fall of Max. See if you can spot me in the video - I'm wearing a lady's cream wide-brimmed sunhat. To my mind, this is perfect punk rock: yes, it's angry and political but above all it's a fucking good laugh. I'm also looking forward to the UK Subs, the Damned, Drongos for Europe, the Exploited, Subhumans, Abrasive Wheels and about 100 other bands. Got your tickets yet?

Darwin Celebrations @ UCLAN

I am pleased to announce UCLAN's Darwin Day lecture for this year. The speaker will be Prof Armand Leroi, the evo-devo biologist from ICL whose TV documentary "What Darwin Didn't Know" was on BBC4 earlier this week (if you missed it, you still have until 4th Feb to catch it on the iPlayer). I can also recommend his book "Mutants", which is both fascinating and grotesque.

The lecture, entitled "Thinking Like Darwin", will take place on Tuesday 24th Feb at 7.00pm in the Darwin Lecture Theatre. I hope to arrange refreshments etc from 6.00 as in previous years.

There will be two other events to mark the Darwin bicentenary in February.

On Feb 11, Prof Malcolm Edmunds will give a lecture on "Evolution for Beginners", aimed at all staff and students who would like to know more about how evolution works. This will be in [Edit: lecture moved to a bigger room by popular demand! Now in HARRIS 307] 11.00-1.00 with refreshments provided.

On Feb 9th, Pete Lumsden is organizing a seminar on "Darwin & Faith". The main speakers are Dr Paul Marston and the Rev Michel Roberts (anglican minister and geologist), who will outline and illustrate some of the key moments during Darwin's life, and explore what impact his ideas have had on science and religion - particularly Christianity - in the succeeding years. Darwin Lecture Theatre, 6.00-8.00pm.