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.

Happy Xmas Everybody!

Or "Happy Holidays", as they say here. Yes, I have made my first ever trip to the USA, and amazingly, they let me in. There is so much snow it's unbelievable. Here I am in front of the Madison Boulder, a 5,000 ton glacial erratic, after wading a mile or so through knee-deep powder to get here. There were no other footprints, so we were the first people for days to see it. New Hampshire is astonishingly beautiful.

It's Christmas Day already in England, but there's a few hours to go here. Time to pour a bourbon. Have a good one!

Update added Xmas day:

We walked up by the boulder again today, and met a real nice American couple called Bert and Sue. And waddya know? Bert turns out to be a Leeds fan! Here we all are together. Bert has more brains than the average Loiner (especially the ones who taunted Gary MacAllister last week to the tune of Jimmy Mack: "Ooh Gary Mac, you're gonna get the sack") and told me it was a stupid mistake to sack Macca just before we play Leicester. Still, at least Leeds only spoke to Simon Grayson AFTER he had resigned from Blackpool. Heh, even Bert doesn't believe that one! Happy Christmas...

Autism's False Prophets

This could be the most important book of 2008, but it has hardly made a ripple yet on this side of the pond, despite giving a starring role to our own Andrew Wakefield. It is Autism's False Prophets, by Paul Offitt, an American vaccinologist, co-inventor of the rotavirus vaccine and director of the Vaccine Education Centre in Philadelphia. If you have read Ben Goldacre's articles about the great MMR hoax and would like to know more, buy this book. In fact, since all Paul's royalties are going to autism research, buy two (it doesn't seem to have been published in a UK edition yet, but you can easily get one from Amazon for about a tenner). If you have the slightest doubts about vaccine safety, it will reassure you. Does anyone still need such reassurance? You might think the debate is over, the argument won, but several events this week have combined to prove that this is far from the case.

First came the news that the number of measles cases in the UK has risen above 1,000 this year for the first time since 1995. Over 150 children have been hospitalised by the disease, and one has died. Why? One reason is poor uptake of the MMR vaccine: only around 75% of children have received both doses by the time they start school, well below the 95% target necessary to ensure herd immunity.

Then came a Guardian poll and Comment Is Free thread, which saw an astonishing number of antivaxers crawling out into the sunlight, repeating all their tired (and thoroughly debunked) conspiracy theories. As Gimpy has pointed out, the poll was very badly worded and made it easy for the idiots to hijack the platform. It is worth reading through the comments, though, to see that there are still many people who believe (for example) that the Simpsonwood meeting was convened in secret to plan a coverup of the dangers of Thimerosal in vaccines. These people cite Robert Kennedy Jr, Jenny McCarthy and Thoughtful House as credible sources, while ignoring the vast piles of evidence that prove Thimerosal is safe. This shows how hard it is to argue with conspiracy theorists, because every bit of evidence against them merely serves to prove that the conspiracy is even bigger than they thought. Now, by writing this, I am in it too.

Now comes the story that should be the final nail in the coffin of the MMR hoax. Throughout the media furore over MMR in 2001-2002 there did seem to be one piece of evidence in favour of Wakefield's hypothesis: the presence of vaccine-strain measles virus in the guts of autistic children. Despite the large-scale epidemiological studies showing that MMR was generally safe, it remained a possibility that a subgroup of children might be at risk, perhaps because of some as-yet-unknown predisposing factor. This was roughly the position taken by Private Eye in their notorious 2002 supplement MMR: The Story So Far, and it made reasonable sense at the time. My son had his MMR in March 2002 (and again in 2005) without a moment's hesitation because it was clear than any risk was tiny and completely offset by the benefits, but I wasn't 100% convinced by the arguments of the MMR defenders because they could not explain Wakefield's virus samples. That changed in 2006, when it became clear that his results were false positives: new studies (reported by Ben Goldacre but hardly anybody else) had failed to find any measles virus in gut tissue from autistic children. Now we can see exactly what went wrong, and how Wakefield's samples were contaminated.

Will this end the debate, as it should? Of course not! Offitt's book lays bare the lunacy of the antivaxers: their willingness to dismiss anything contaminated by Big Pharma, their enthusiasm for alternative therapies, no matter how stupid or dangerous. Since he began his campaign to educate people about vaccine safety, he has become a target for hate mail and even death threats, but he remains upbeat and writes with good humour about his experiences. Several major vaccine-safety court cases will end in the next few months: let us hope science and reason triumph over passion and hatred. In the meantime, buy this book.