BBC publish inaccurate information about a paper before paper is published

There has been some debate following an article on Ed Yong’s blog on the need or otherwise for embargoes in science journalism stemming from a debate at the World Conference of Science Journalists, which in my opinion ignores a particular bugbear of mine regarding embargoes.  Namely, mainstream organisations publicising science stories before the research is available to researchers with subscriptions to the journal it was published in.
Take this article from the BBC on Caffeine and Alzhemiers disease, for example.  “Coffee ‘may reverse Alzheimer’s‘” says the headline, note the use of what Language Log calls ‘mendacity quotes‘, indicating that the headline probably does not reflect the content of the article.  “Drinking five cups of coffee a day could reverse memory problems seen in Alzheimer’s disease (AD), US scientists say.” says the bolded standfirst, in an example of what I, lacking the the diplomacy of Language Log, call a lie.  The article actually describes research on an Alzheimer’s disease model in mice noting that “The mice were given the equivalent of five 8 oz (227 grams) cups of coffee a day – about 500 milligrams of caffeine.“, so that’s mice, given a fixed dose of caffeine, not humans drinking five cups of coffee (cup of what – espresso, latte, weak American pseudo-coffee?).  The article goes on to say “When the mice were tested again after two months, those who were given the caffeine performed much better on tests measuring their memory and thinking skills and performed as well as mice of the same age without dementia.“.  Is this true?  This would be remarkable.  How can I find out?  I could read the paper, unfortunately the BBC don’t link to the paper, just the journal, and it turns out the paper has not been published yet.  The abstract is available and we know the research will be published in Volume 17 Number 3 of the Journal of Alzheimers Research but we don’t know the details beyond the abstract.

Gary W. Arendash, Takashi Mori, Chuanhai Cao, Malgorzata Mamcarz, Melissa Runfeldt, Alexander Dickson, Kavon Rezai-Zadeh, Jun Tan, Bruce A. Citron, Xiaoyang Lin, Valentina Echeverria, Huntington Potter
Caffeine Reverses Cognitive Impairment and Decreases Brain Amyloid-β Levels in Aged Alzheimer’s Disease Mice
Abstract: We have recently shown that Alzheimer’s disease (AD) transgenic mice given a moderate level of caffeine intake (the human equivalent of 5 cups of coffee per day) are protected from development of otherwise certain cognitive impairment and have decreased hippocampal amyloid-β (Aβ) levels due to suppression of both β-secretase (BACE1) and presenilin 1 (PS1)/g-secretase expression. To determine if caffeine intake can have beneficial effects in “aged” APPsw mice already demonstrating cognitive impairment, we administered caffeine in the drinking water of 18-19 month old APPsw mice that were impaired in working memory. At 4-5 weeks into caffeine treatment, those impaired transgenic mice given caffeine (Tg/Caff) exhibited vastly superior working memory compared to the continuing impairment of control transgenic mice. In addition, Tg/Caff mice had substantially reduced Aβ deposition in hippocampus (down 40%) and entorhinal cortex (down 46%), as well as correlated decreases in brain soluble Aβ levels. Mechanistically, evidence is provided that caffeine suppression of BACE1 involves the cRaf-1/NFκB pathway. We also determined that caffeine concentrations within human physiological range effectively reduce active and total glycogen synthase kinase 3 levels in SweAPP N2a cells. Even with pre-existing and substantial Aβ burden, aged APPsw mice exhibited memory restoration and reversal of AD pathology, suggesting a treatment potential of caffeine in cases of established AD.

To be fair to the BBC, the abstract does bring up the cup of coffee factoid, something the authors should be more careful about, but it does not say that the mice performed as well as those without dementia, only that they ‘exhibited memory restoration and reversal of AD pathology’, it does not put a value on that restoration and reversal.

This seems like interesting research, delaying or even reversing AD is an important outcome given an aging population and it would be fascinating if simple dietary methods, such as caffeine consumption, could have measurable effects.  But this research does not show this in humans, it uses a mouse model of disease and, while it is interesting and important, represents just a small step forward in an understanding of an AD model – it does not justify caffeine consumption to prevent AD or justify the BBC headline.  The BBC have put an inaccurate headline and inaccurate standfirst into the public domain prior to the research being available to journal subscribers.  The public impression of this research is now likely to be at odds with the reality, not only that by privileging the media publication over the scientific publication the journal has concluded that the public should receive priority in receiving inaccurate interpretations of research over subscribers reading accurate representation.  And they wonder why there is a problem with science communication?

[BPSDB]

FIH plug Thames Valley University survey

The Prince’s Foundation for Integrated Health (FIH) are plugging a survey by Thames Valley University (TVU) examining patients and medical practitioners attitudes to complementary medicine (CAM).  Quite apart from containing the following amusing graphic, the FIH article could be seen as an attempt to influence the survey by directing participants naturally predisposed to CAM, hence their browsing of the FIH site, to it.

This could create a fundamental bias in survey participants and result in a survey reflecting the views of a narrow subset of society without any indication that this is the case.  I’m sure that this is not the intended case, and the apparent omission of uninterested non-users, “meh”, in the graphic above does not reflect the researchers own bias.

To correct this apparent oversight in not broadcasting their survey to a wider audience I would urge all readers of this blog to complete the survey, if they fit the required criteria, and to pass it on to their friends and family.

I also note that TVU, and the FIH, have suggested that people involved in public health care display this poster in their public spaces.

I feel that this poster is missing some important detail.  After all it does not state why you should tell your doctor about these therapies nor indeed provide any important information on them.  To rectify this I have made some small additions and would urge any health professionals reading this blog and wanting to use the poster to use the following version instead.

[BPSDB]

*update*

Minor amendements to poster – clarified role of Mao & changed advice on vitamins

BCA plethora – the previously unavailable Fallon paper

When I had a look at the papers in the British Chiropractic Association’s (BCA) ‘plethora’ for ear infection I noted that I could not access the Fallon JM (1997) paper of which the BCA claim  ‘[t]he results indicate that there is a strong correlation between the chiropractic adjustment and the resolution of otitis media for the children in this study.’, I did, however, criticise it based on the abstract, admittedly a slightly dangerous thing to do, given that abstracts do not always accurately reflect the content of the paper.

“Looking at it it seems not to involve a control group, thus cannot tell us anything about the efficacy of chiropractic vs other treatment or placebo, and is more of an argument for the use of a measuring technique in assessing the impact of chiropractic rather than the BCA’s stated claim.  In fact, the BCA’s (and the author’s) claim about a correlation is disingenuous given that in the absence of a placebo control it is impossible to say if the correlation is due to a placebo effect, the BCA (and the author) would do well to remember that correlation is not proof of causation.”

Now I have been sent a copy of the paper and coincidentally almost simultaneously found it online, here, so I can confidently reiterate my previous criticism after having read it.  However there are several discrepancies between the figures in the paper and those in the abstract which indicate a somewhat slipshod approach to detail.  The abstract states that:

The body text of the paper indicates that:

It is clear that the while the initial pool of participants was 332, only 315 of these took part in the study, despite the abstract appearing to claim otherwise.  Now it is perfectly normal for subjects to be excluded from any medical study for any number of reasons and the small number of participants lost will not affect the validity of the results, the lack of control see to that, but it is an unfortunate proofreading error.  Of course one should be willing to accept a small amount of human failing in data presentation and occasional lapses are forgivable.  However, there are several other such lapses in the abstract.

The data for the average number of adjustments in the body text is as follows:

You will of course notice that the data given in the abstract for Acute OM, 4.0±1.03 varies slightly from that given in Table 15, 4.09±1.03 – the 9 has been left off.  Rounding of the digits is not a plausible explanation as the error is given to two decimal points (and oddly some numbers are given to one decimal point while the error is given to two).  A lack of proofreading seems to be the case.  These errors continue with respect to the normalization data:

Again the careful reader will notice that the data given in the abstract for normalisation of otoscopic exam for Acute OM, 6.67±1.9, varies from that in Table 17, 6.67±1.99.  Again a digit has been lost from a decimal place, and once again the 9.

Now, these errors in the abstract do not appear to misrepresent the general thrust of the paper, the lack of control groups does that, but they do indicate that maybe the peer review wasn’t thorough enough in picking up such obvious mistakes, if it was peer reviewed at all.  It does make you wonder if such a slipshod attitude to review permeates the approach to references or experimental detail.  Perhaps an unfair criticism, and I don’t have the time to investigate the references and reanalyse the data (feel free in the comments), but I would not be having these thoughts if such obvious typographical errors had not been made.

Another strange detail in the paper, unrelated to its validity – the lack of control groups renders this suspect, is that it makes numerous references to ‘allopathy’.  Now allopathy was a term invented by the founder of Homeopathy, Samuel Hahnemann, to denigrate conventional medicine, as it was then – it implies that conventional medical practices cause unnecessary harm through their treatments.  Its continued modern usage is a shibboleth of alternative medical practitioners who maintain its deregotary usage, its use in this paper indicates that the author may thus have deregotary feelings about conventional medicine.  This is a minor detail unrelated directly to the BCA’s case but it does suggest that at least some chiropractors see themselves as a replacement rather than a adjunct to modern medical practice.

There is also some doubt as to whether or not the BCA even read this paper before adding it to their ‘plethora’.  A correspondent requested the paper from a representative of the BCA, who indicated they had only just received a copy from the AECC chiropractic college – the document does indeed bear an AECC library stamp.I hope the BCA did read this paper prior to issuing their plethora.  To claim that “there is actually a significant amount” of evidence supporting chiropractic without actually having read it would indicate that their position on the stupidity spectrum is perilously close to moving from visibly stupid to ultra stupid.

Thanks to John.

*update*

Colin in the comments points out that:

I poked around a little, and it turns out that Joan Fallen co-founded the organisation that publishes the journal JCCP and she’s been on the board (sometimes as chair) ever since. I’ve got more detail on my blog at http://www.blue-genes.net/2009/07/the-bca-plethora-of-evidence-the-fallon-paper/ . And yes, the stated aim of the ICACCP is to promote the use of chiropractic for children

This is all very incestuous and it does create the question, is this paper part of a lobbying effort to encourage the use of chiropractic for children rather than just research?

Mozambique show how to regulate homeopathy in Africa

Via the quackometer’s twitterfeed, a story on the allAfrica news aggregation site suggests that the government of Mozambique are responding in a thoroughly sensible manner to alternative medicine practitioners, including homeopaths.

Health Minister Ivo Garrido argues that practitioners were operating in a ‘legal vacuum’ and thus it was necessary to regulate them by law.  One possible effect of this law is that:

Any practitioner of “alternative” medicine could be regarded as “professionally incompetent” since the remedies he prescribes have no scientific basis, and at best act as placebos.

Thus the new bill is not a blank cheque for medical frauds, but may instead restrict their activity.

Well done Mozambique.  I hope other countries follow suit.

[BPSDB]

A grumble on the poor quality of a libertarian discourse on passive smoking

Spiked presents itself as “an independent online phenomenon dedicated to raising the horizons of humanity by waging a culture war of words against misanthropy, priggishness, prejudice, luddism, illiberalism and irrationalism in all their ancient and modern forms.” – a statement of intent that in this wordy form oozes smirking superiority and arrogance but is attractive in principle. I am a firm believer in robust debate, wide ranging freedoms of speech and expression, including the right to be wrong, offensive and offensively wrong. I also believe that evidence is important in forming conclusions. I suspect that Spiked don’t, offering lightweight arguments of irresponsibility masquerading as concern for liberties instead.  Take this article by Suzy Dean on passive smoking for example. Dean is critical of arguments made by medical experts suggesting that the government should consider a ban on smoking in cars when children under 16 are present.
Dean sets out her case by arguing that the House of Lords Economic Affairs Committee published a report on the government’s management of risk concluding that environmental tobacco smoke (ETS) is not the threat it’s purported to be and therefore did not justify a ban. Before suggesting that “much of the science which makes up the passive-smoking case fails to mention that smoking-related illnesses – like lung cancer, cardiovascular disease and respiratory disease – are the product of a number of factors, such as genetics and diet, in addition to the amount of exposure to tobacco smoke.”.

The BCA have no evidence that chiropractic can help with ear infections

Based on this quote from Simon Singh the British Chiropractic Association (BCA) decided to sue him for libel:

“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.”

The BCA claimed that there was a ‘plethora of evidence’ supporting their position and disproving Simon Singh’s, the BCA have now released a statement and listed their evidence and make the claim that

This proves that far from there being “not a jot of evidence” to support the BCA’s position, there is actually a significant amount

A number of blogs have taken it upon themselves to assess the strength of the papers against the claims the BCA make for it.  I will be doing the papers on frequent ear infections of which there are three, suggesting that the BCA’s definition of plethora is even further estranged from that of the dictionary than Judge Eady’s interpretation of ‘bogus’.

The BCA claim that Mills MV et al (2003) ’suggest[s] a potential benefit of osteopathic manipulative treatment [(OMT)] as adjuvant therapy in children with recurrent acute otitis media; it may prevent or decrease surgical intervention or antibiotic overuse’, an almost verbatim quote from the abstract’s conclusions.  However, the BCA have not explored the faults of the paper, many of which the authors draw attention to, such as using fewer patients than their preliminary statements suggest as necessary:

Results of power analysis suggested we would need 50 children in each group, on the basis of a predicted 50% decrease in antibiotic use, episodes of AOM in the group receiving medical treatment alone, and a 75% improvement in the group receiving medical treatment and OMT. With a type I error rate set at .05, we estimated an expected power of 85% if there were a 10% dropout rate and a power of 80% with a 20% dropout rate.

There were 25 patients in the intervention group and 32 in the control group considerably raising the possibility of a type I error, a false positive result, in the statistical interpretation of data.   This is likely to have happened given the range of variable assessed by the authors (Table 2 below).  Also the authors’, and the BCA’s, contention that this may decrease antibiotic overuse seems untenable given the lack of statistical significance regarding antibiotic usage during the study (P=0.13).

*update*

Richard in the comments points out:

That the Mills et al (2003) is smaller than their power test suggested was needed does not affect the type I error (incorrectly rejecting the null hypothesis). Instead it increases the risk of a type II error (incorrectly accepting the null hypothesis). As such, the small size of the study works against them.

The greater problem is that they make 23 tests without, apparently, correcting for multiple comparisons. This will massively inflate the risk of type I errors and it is not in the least surprising that they have a couple of apparently significant results.

The authors also did not use a placebo control:

The issue of whether to include a placebo control for the control group was considered. If we had included a placebo control, any presumed placebo intervention might have had an unintended treatment effect, introducing potential confounding variables and necessitating 3 groups: intervention, placebo intervention, and nonintervention. We chose instead for this study to report any difference in outcomes between 2 groups that were selected to be as equal as possible except for the application of OMT. Placebo effect due to the number of visits was minimized by the design of the study, leaving the influence of touch as potentially having a placebo effect. Larger studies are needed to replicate and elucidate the causal mechanisms of this effect.

The authors are acknowledging here that they cannot distinguish between the placebo effect of touching a patient and the OMT treatment.  Therefore their investigations cannot say whether OMT has an effect above placebo.  The study might suggest a benefit, but only if you throw caution to the wind and ignore chances of false positives and make the a priori assumption that OMT can have an effect on ear infections, in which case you would be bringing considerable bias into your interpretation. After all you would have to ignore the awkward fact that there is no conceivable way in which OMT could effect the immune response to infection or actively contribute to the reduction of infection in any other way.

The BCA claim that Froehle RM (1996) shows that ‘93% of all episodes improved. The study’s data indicates that  … the addition of chiropractic care may decrease the symptoms of ear infection in young children’.  The study has no control group and is little more than a collection of case notes on the duration of ear infection, of which the author notes ‘very little data was found regarding the natural course of ear infections’.  Therefore the study says nothing about the impact of chiropractic care on the duration of ear infection compared to the natural course of healing but it does say infections get better over time.  This is not evidence supporting the use of chiropractic care in ear infection so much as supporting evidence for the old adage that time heals all wounds.

I cannot get access to the Fallon JM (1997) paper which the BCA claim of which ‘[t]he results indicate that there is a strong correlation between the chiropractic adjustment and the resolution of otitis media for the children in this study.’ as it is not listed in a PubMed indexed journal.

*update*

Thanks to everyone in the comments and others for providing the link to the abstract of this paper.  Looking at it it seems not to involve a control group, thus cannot tell us anything about the efficacy of chiropractic vs other treatment or placebo, and is more of an argument for the use of a measuring technique in assessing the impact of chiropractic rather than the BCA’s stated claim.  In fact, the BCA’s (and the author’s) claim about a correlation is disingenuous given that in the absence of a placebo control it is impossible to say if the correlation is due to a placebo effect, the BCA (and the author) would do well to remember that correlation is not proof of causation.

This ‘plethora’ of three trials, two of which are very badly designed and one of which is unavailable is available in abstract form only, does not constitute a ’significant amount of evidence’ disproving Simon Singh’s claims.  In fact it strongly suggests that the BCA, in reaching into their basket of evidence, are picking cherries and clutching straws.  Frankly it is embarrassing, this is the equivalent of a child attempting to convince an adult that his colander on a stick is in fact a super intelligent robot, only without the innocence and charm.

*updates*

Details of other blogs covering these papers will be posted later. These links largely copied and pasted from Layscience, will add to later if I have time.

Jack of Kent – General commentary and legal background.
Prof. Colquhuon – Detailed look at the nine colic papers.
Ministry of Truth – General review focusing on three of the colic papers.
Andy – Comment on the BCA statement.
Evidence Matters – Review of the paediatric asthma papers.
Layscience – a review of the flaws in all the papers available
Phil Plait – An overview of the BCA statement and aftermath.
HolfordWatch – What would constitute good evidence?
Apgaylard – A more detailed look at the bed-wetting papers.
JDC – General comment on the BCA statement.
Think Logic – General comment on the BCA statement.

References

Mills MV, Henley CE, Barnes LL, Carreiro JE, Degenhardt BF. The use of osteopathic manipulative treatment in children with acute recurrent otitis media. Arch Paediatr Adolesc Med.  2003 Sep;157(9): 861-6

Froehle RM. Ear infection: a retrospective study examining improvement from chiropractic care and analysing for influencing factors. J Manipulative Physiol Ther 1996 Mar; 19(3): 169-77

Fallon JM. The role of the chiropractic adjustment in the care and treatment of 332 children with otitis media. J Clin Chiropract Paediatrics 1997 Oct; 2(2): 167-183

[BPSDB]

Homeopathic Research Institute’s Head of Clincial research fails to declare conflict of interest

I have signed up for emails from the Homeopathic Research Institute (HRI) as I have a strong masochistic streak.  I received the following the other day about the HRI’s Head of Clinical Research’s research:

We are delighted to be able to circulate to you the abstract of a trial of treatment by a homeopath for Fibromyalgia recently published in the Homeopath, journal of the Faculty of Homeopathy.

http://www.ncbi.nlm.nih.gov/pubmed/19358959

The lead author is Dr Relton, the HRI’s Head of Clinical Research.  She also works at the School of Health and Related Research, University of Sheffield, and the School of Healthcare, University of Leeds.

This study was a pilot pragmatic Randomised Control Trial which looked at the provision of treatment by a homeopath alongside usual care for Fibromyalgia.  It was shown to have clinical relevance and paves the way for a definitive study assessing the clinical and cost effectiveness of providing treatment by a homeopath for Fibromyalgia.

We also want to let you know that we are currently organising a fundraising event which will take place in London on 24th June.  If you are interested in funding the work of the HRI and want to learn more about it, or know of people who are in a position to do so, then please contact us at info@homeoinst.org for details.

Now the paper is not very good, it does not compare homeopathic pills with placebo pills but “the clinical effectiveness of usual care, compared to usual care plus adjunctive care by a homeopath, for NHS patients with a diagnosis of primary FMS who were under the care of consultant rheumatologists.” The control vs adjunctive care is described as follows:

The usual care group received one or more of the following: physiotherapy, aerobic exercise, analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), anti depressants. The homeopath care group received usual care plus an initial one hour in depth interview followed by up to four 30 min in depth interviews (4–6 weeks apart) with individually tailored homeopathic medicines prescribed at each interview.

In other words it assesses, not the efficacy of homeopathy, but the efficacy of a chats with a sympathetic person (who happens to be a homeopath) plus a dose of sugar pills – which can be considered placebo as homeoapthy is so implausible.  Any postive result would be better explained by the placebo effect from the chat than a treatment whose proposed method of action is impossible given current scientific understanding.  This is all very boring and is little more than homeopaths scratching in the dirty margins of statistical significance for nuggets of fool’s gold.  More interesting is the declaration of interest by the paper’s authors:

Conflict of interest

None.

This simply isn’t true.  Dr Relton works for the HRI and they are making an appeal for funds based on the findings of her research.  Her drawing positive conclusions about homeopathy in her research is linked to the financial survival of the HRI.  Dr Relton can be considered a shill for the HRI by not declaring this conflict of interest in the paper.  Once again homeopaths, who criticise their critics as big pharma shills and jump on any percieved conflict of interest, behave in the manner they are so quick to condemn.

McTimoney Chiropractic Association cut and run

Thanks to Andy Lewis and Richard Lanigan* I have come across this email from the McTimoney Chiropractic Association (MCA), one of the bodies representing chiropractors.

Date: 8 June 2009 09:12:18 BDT

Subject: FURTHER URGENT ACTION REQUIRED!

Dear Member

If you are reading this, we assume you have also read the urgent email we sent you last Friday.  If you did not read it, READ IT VERY CAREFULLY NOW and  – this is most important – ACT ON IT.  This is not scaremongering.  We judge this to be a real threat to you and your practice.

Because of what we consider to be a witch hunt against chiropractors, we are now issuing the following advice:

The target of the campaigners is now any claims for treatment that cannot be substantiated with chiropractic research.  The safest thing for everyone to do is as follows.

1. If you have a website, take it down NOW.

When you have done that, please let us know preferably by email or by phone. This will save our valuable time chasing you to see whether it has been done.

1. REMOVE all the blue MCA patient information leaflets, or any patient information leaflets of your own that state you treat whiplash, colic or other childhood problems in your clinic or at any other site where they might be displayed with your contact details on them.  DO NOT USE them until further notice. The MCA are working on an interim replacement leaflet which will be sent to you shortly.

1. If you have not done so already, enter your name followed by the word ‘chiropractor’ into a search engine such as Google (e.g. Joe Bloggs chiropractor) and you will be able to ascertain what information about you is in the public domain e.g. where you might be listed using the Doctor title or where you might be linked with a website which might implicate you. We have found that even if you do not have a website yourself you may still have been linked inadvertently to a website listing you or your services.

CHECK ALL ENTRIES CAREFULLY AND IF IN DOUBT, CONTACT THE RELEVANT PROVIDER TO REMOVE YOUR INFORMATION.

CHECK OUR PREVIOUS EMAILS FOR SPECIFIC ADVICE AND KEY WORDS TO AVOID.

KEEP A LOG OF YOUR ACTIONS.

1. If you use business cards or other stationery using the ‘doctor’ title and it does not clearly state that you are a doctor of chiropractic or that you are not a registered medical practitioner, STOP USING THEM immediately.

5.   Be wary of ‘mystery shopper’ phone calls and ‘drop ins’ to your practice, especially if they start asking about your care of children, or whiplash, or your evidence base for practice.

IF YOU DO NOT FOLLOW THIS ADVICE, YOU MAY BE AT RISK FROM PROSECUTION.

IF YOU DO NOT FOLLOW THIS ADVICE, THE MCA MAY NOT BE ABLE TO ASSIST YOU WITH ANY PROCEEDINGS.

Although this advice may seem extreme or alarmist, its purpose is to protect you.  The campaigners have a target of making a complaint against every chiropractor in the UK who they perceive to be in breach of the GCC’s CoP, the Advertising Standards Code and/or Trading Standards.  We have discovered that complaints against more than 500 individual chiropractors have been sent to the GCC in the last 24 hours.

Whatever you do, do not ignore this email and make yourself one of the victims. Some of our members have not followed our earlier advice and now have complaints made against them.  We do not want that to happen to you.

Even if you do not have a website, you are still at risk. Our latest information suggests that this group are now going through Yellow Pages entries. Be in no doubt, their intention is to scrutinise every single chiropractor in the UK.

The MCA Executive has worked tirelessly over the last week keeping abreast of development and contacting at risk members.  We have decided that this is our best course of action to protect you and the Association at this time of heightened tension.  This advice is given to you solely to protect you from what we believe is a concerted campaign, and does not imply any wrongdoing on your part or the part of the Association.  We believe that our best course of action is simply to withdraw from the battleground until this latest wave of targeting is over.

Finally, we strongly suggest you do NOT discuss this with others, especially patients, Firstly it would not be ethical to burden patients with this, though if they ask we hope you now have information with which you can respond.

Most importantly, this email and all correspondence from the MCA is confidential advice to MCA members alone, and should not be shared with anyone else.

Please be aware that the office phone lines are likely to be busy, so, if you need our help, please send an email to the office and we will get back to you as soon as we can.

Yours,

Berni Martin

MCA Chair.

Best wishes,

Nicki

Nicki Choules-Rowe

Administrative Officer – Executive Liaison

McTimoney Chiropractic Association

Crowmarsh Gifford

Wallingford OX10 8DJ

Tel : 01491 829494

It looks like the McTimoney school were aware that their members were promoting treatments unsubstantiated by research and promoting themselves as doctors as they admit that “Some of our members have not followed our earlier advice and now have complaints made against them”.  I also looks like they have contempt for fully informing their patients/customers about the furore over the evidence base for their claims, “we strongly suggest you do NOT discuss this with others, especially patients”.

This is astonishing.  This is an organisation representing chiropractors assisting them in hiding their dodgy business practices from prying eyes.  It looks like the culture of secrecy and fear of open debate that drove the British Chiropractic Association (BCA) to silence Simon Singh in the libel courts is widespread amongst the chiropractic community.  It also points to a schism developing amongst the chiropractic community, the MCA have decided to “withdraw from the battleground until this latest wave of targeting is over” – so much for supporting their fellow chiropractors.

It will be fascinating to see how this develops.

*Richard Lanigan has interesting opinions and an axe to grind regarding the GCC so caution is required when reading but his site is a useful resource.

Homeopaths plot to broadcast idiocies on twitter

So you belong to a profession that has recently come under some criticism for lacking an understanding of medical ethics and indulging in some frighteningly irresponsible pseudo-medical posturing, you’re concerned about shifting media attitudes, you feel there is a lack of support within society, what do you do?

Do you engage in a period of self reflection, invite serious commentary on and within the profession, encourage responsible behaviour and punish that which brings your community into considerable disrepute?  Or, do you just confirm every allegation of ignorance, irresponsibility and idiocy made about you by your critics?

Dear Leaders of Homeopathy

This is an action alert in response to the recent attacks on the validity of homeopathy presented to the World Health Organization.

http://www.guardian.co.uk/science/2009/jun/01/world-health-organisation-homeopathy-hiv

In an effort to have our positive messages heard in the media we ask you to send out the email below to your entire mailing list.

Sincerely

Debby Bruck, CHOM.

Founder of HWC Homeopathy World Community

http://www.homeopathyworldcommunity.com

———— ——— ——— ——— ——— ——— -

Dear Friends and Supporters of Homeopathy
This is an action alert in response to the recent attacks on the validity of homeopathy presented to the World Health Organization.

We are asking you to take these four easy steps to have our positive messages about homeopathy heard around the world. Using the micro-blog tool Twitter, you can help bring keyword homeopathy up in the search engines. It is very easy to use and we will help you get started. So do this right now without delay.

1. Go to http://twitter.com
2. Sign up by typing your real name without a space in between the first and last name and create a password
3. Upload your photo
4. In the “What you are doing?” window enter each of the posts below (copy & paste one at a time, clicking Update after each).

Oxford University Press study | #homeopathy medicines have effect on cancer cells & genes http://budurl. com/FBDA

81% of patients receive CAM treatments on referral from GP #homeopathyhttp://budurl. com/PCAM

Dr. Pawan Pareek Clinical Evidence | #Homeopathy Treatment http://budurl. com/Pareek

Research Supporting #Homeopathy http://budurl. com/19535

The threat of a global pandemic & evolving #homeopathy treatment strategyhttp://budurl. com/DrBhatia

____________ _________ _________ _________ ________

Thank you so very much for being part of this 24-hour Twitter Campaign Marathon. If everyone around the world posts these messages [and more if you are so inclined] then we will have started a great wave of positive energy creating awareness and educating the public.

Thank you,
Your Signature

a.. PS. If you run a homeopathic school please make it an assignment. It only takes a few minutes to make a tremendous impact.
b.. Seven Reasons Homeopaths Should Join Twitter
http://homeopathyworldwide.blogspot.com/
c.. Please join HWC http://homeopathyworldcommunity.com
———— ——— ——— ——— ——— ——— -

British Chiropractic Association tell their members to hide their sins from prying eyes

Via BlueWode I have come across the text of this letter, posted on ex- General Chiropractic Council (GCC) board member Richard Lanigan’s blog*, sent out by the British Chiropractic Association (BCA) on the 4th June.

The BCA would remind members of their obligations under the Advertising Standards Authority (ASA) section 50 (relating to Health & Beauty Products and Therapies: see

Members are strongly encouraged to review their current marketing materials (whether they are paper- or web-based to ensure that they are compliant with both ASA and GCC requirements. Note that the ASA has no jurisdiction over editorial materials placed on members own websites.

When reviewing your materials it may be helpful to consider the following:

1. Are there any claims made that cannot be justified by reference to evidence? Remember, the GCC requires chiropractors to practice evidence based care, which is defined as “clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of practitioners (which includes the individual chiropractor himself).

2. Be mindful of making promises that you cannot be sure of delivering on;

3. Be wary of listing conditions that are controversial and away from mainstream chiropractic care e.g. dyslexia/dyspraxia unless you have research to back this up. If you have made references to prolonged crying, sleep and feeding problems, breathing difficulties and frequent infections, as these are symptoms rather than condition specific, we suggest you remove these references.

4. Do not refer to yourself as a specialist in any particular form of chiropractic;

5. Do not use unfamiliar words for common conditions;

6. Do not unjustly criticise other healthcare professionals;

7. If you refer to subluxations, provide information to explain what they are.

8. Take care in the use of the Doctor title. Ensure that there is no way there can be any doubt that you are a chiropractor, and not a registered medical practitioner. Do not use the doctor title in paper advertising without explicitly stating that you are a chiropractor.

It is great to see the BCA finally taking responsibility to moderate the excess of their members but it is a shame it is a cowardly and pitiful PR exercise in response to their spectacular misjudgement in suing Simon Singh.  One of the reasons professional organisations, such as the BCA, should exist is to make sure professional values are upheld, there has clearly been a monumental failure in this regard if people are finding reason to complain to the ASA, GCC and Trading Standards.  Such failure is unsurprising however, the BCA point out to their members that “the ASA has no jurisdiction over editorial materials placed on members own websites”, which read as an implicit acceptance of members making false claims on their websites.  No wonder the BCA prefer to silence criticism through the courts.  False claims and misrepresentation seem to have been the bedrock of the profession since at least 1913

*update*

As Mojo in the comments points out, although the BCA claim that “the ASA has no jurisdiction over editorial materials placed on members own websites.”, the GCC’s code (C1.6) states that:

[chiropractors] may publicise their practices or permit another person to do so consistent with the law and the guidance issued by the Advertising Standards Authority.

Therefore BCA members (who must be GCC registered) are obliged to uphold ASA rulings, even on their websites.  So are the BCA endorsing their members posting claims on their websites that the GCC prohibit?  Maybe, maybe not – but this does make the BCA look even more incompetent.

[BPSDB]

*Richard Lanigan has interesting opinions and an axe to grind regarding the GCC so caution is required when reading but his site is a useful resource.

Chiropractic – as modest today as in 1913?

I have come across this wonderful comment about chiropractic from the California State Journal of Medicine, 1913 [1].

I’m afraid I don’t have time today but if anybody fancies taking on a project to compare the claims made in this clipping with the first date research on them was published in a PubMed indexed journal then post your findings in the comments and I’ll transpose them to the article.  I suspect that the research to validate the claims was made some considerable time after the claims were found to be profitable.

[1] Cal State J Med. 1913 June; 11(6): 213.

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Simon Singh to appeal libel decision

Simon Singh has decided to appeal the grossly unfair and astonishingly illiberal ruling from Sir David Eady in the libel case over an article he wrote in The Guardian newspaper brought about by the British Chiropractic Association.  The charity Sense About Science working with Simon Singh are launching a campaign to highlight issues raised by this case, I will be adding my name to the great and the good who have already signed the statement below, I hope you will too.

This is a risky and brave decision by Simon Singh.  There is no guarantee that he will win, British libel law is notoriously unfair, with success often decided by wealth than by ideals of fairness.  Nevertheless Simon Singh must be supported, science and science communication depends on the free and frank exchange of ideas and accepting criticism is a necessity, not a choice.  All too often we have seen those who peddle pseudoscience, nonsense and bogus treatments resort to threats and actions involving lawyers and libel in attempts to silence their critics.  A clear message needs to be sent that those who care about evidence, science and free debate will not stand for such behaviour.

The campaign website is below:

http://www.senseaboutscience.org.uk/freedebate

Sign the Support Statement.

Also, download the campaign button and add it to your website.

A rolling update of the blogosphere’s reaction to Simon Singh and the BCA is kept by Chris Kavanagh here.

The law has no place in scientific disputes

We the undersigned believe that it is inappropriate to use the English libel laws to silence critical discussion of medical practice and scientific evidence.

The British Chiropractic Association has sued Simon Singh for libel. The scientific community would have preferred that it had defended its position about chiropractic for various children’s ailments through an open discussion of the peer reviewed medical literature or through debate in the mainstream media.

Singh holds that chiropractic treatments for asthma, ear infections and other infant conditions are not evidence-based. Where medical claims to cure or treat do not appear to be supported by evidence, we should be able to criticise assertions robustly and the public should have access to these views.

English libel law, though, can serve to punish this kind of scrutiny and can severely curtail the right to free speech on a matter of public interest. It is already widely recognised that the law is weighted heavily against writers: among other things, the costs are so high that few defendants can afford to make their case. The ease and success of bringing cases under the English law, including against overseas writers, has led to London being viewed as the “libel capital” of the world.

Freedom to criticise and question in strong terms and without malice is the cornerstone of scientific argument and debate, whether in peer-reviewed journals, on websites or in newspapers, which have a right of reply for complainants. However, the libel laws and cases such as BCA v Singh have a chilling effect, which deters scientists, journalists and science writers from engaging in important disputes about the evidential base supporting products and practices. The libel laws discourage argument and debate and merely encourage the use of the courts to silence critics.

The English law of libel has no place in scientific disputes about evidence; the BCA should discuss the evidence outside of a courtroom. Moreover, the BCA v Singh case shows a wider problem: we urgently need a full review of the way that English libel law affects discussions about scientific and medical evidence.

Signed

Homeopaths organise mass letter writing campaign against Simon Singh and applaud BCA

Simon Singh is being sued for libel by the British Chiropractic Association (BCA) and has generated substantial levels of support for his predicament as many see this as an issue of free speech.  Sadly the Homeopathy Worked For Me organisation are not so fond of SImon’s freedom of speech despite being very much in favour of their own freedom to launch unsubstantiated criticism and personal attacks in a lenghty critique of Simon Singh’s and Edzard Ernst’s ‘Trick or Treatment’, of which Andy Lewis of the Quackometer comments

Its clumsy rhetoric and lengthy nitpicking is a disguise of the embarrassment that homeopaths have over the fact that they cannot produce any reliable evidence for the efficacy of their treatments and the validity of their hypotheses (not theories). This pamphlet may well please the homeopaths who continue to avoid acknowledging the genuine and urgent criticisms of their shabby trade (such as their refusal to condemn the practices of their colleagues who dish out sugar pills in Africa in order to ‘prevent’ malaria or treat HIV infection). More competent readers will not be impressed.

Homeopathy Worked For Me have a spectacularly snide piece up on their site that rejoices in mean spirited and inaccurate remarks about Simon Singh and doesn’t really seem to grasp the concept of free speech anyway.

Few homeopaths have found that Singh defends their right to free speech when they are attacked in the press. Indeed Singh has shown that he is quite happy to join with those who misrepresent the facts about homeopathy, the facts about medicine and the facts about science itself.

Clearly Homeopathy Worked For Me haven’t grasped that freedom of speech means the freedom to criticise.  In fact they have gone so far as to encourage their readers to submit complaints based on their template to the editor of the Observer who had the temerity to publish an article by Nick Cohen supporting Simon Singh.

Dear Editor

I am shocked/amazed/surprised to find that the Observer is willing to support Simon Singh in respect of the libel case brought against him by the British Chiropractic Association.

Simon Singh made his statements about the BCA on the basis of Trick or Treatment?, a book he co-authored with Edzard Ernst. A detailed study by Homeopathy: Medicine for the 21st Century has shown that this book ”has no validity as a scientific examination of alternative medicine”, which means that he had no factual basis for his remarks.

Alleging that an organisation “happily promotes bogus treatments” without having any evidence to back such a claim is not an issue of free speech, but of libel, and Simon Singh has justifiably been called to account. For a respected newspaper to defend groundless accusations as “free speech” is to make a mockery of its claims to report the world honestly.

We urge you to reconsider your support for someone who has shown himself prepared to refdefine[sic] science and to misrepresent the facts in order to defend his beliefs.

Yours faithfully

That last sentence alone would break even the strongest irony meter.

Homeopathy Worked For Me confirm once again that quacks are incapable of engaging with criticism in a reasonable and rational manner, preferring instead that debate be silenced.

[BPSDB]

The Green Party’s policies have the potential to destroy biological research

Science bloggers Frank Swain and Martin Robbins, of Sciencepunk and Layscience respectively, have an article on The Guardian website and in depth reportage on their own sites analysing the science policies of the various UK political parties standing in the forthcoming EU elections on 6th June.

The Green Party, one of the parties analysed by Frank and Martin, are expected to pick up protest votes from voters disillusioned with the Labour Party in particular.   I have concerns with Green Party policy in one area in particular, genetic modification (GM).  For those readers who do not know I am a researcher in biological sciences who performs  genetic modification for the purposes of academic research.  The Green Party manifesto states that:

ST360 The EU proposal to extend patents legislation to living matter is unacceptable on the following grounds:

1.The proposals imply a relationship between humans and nature where it is acceptable to manipulate life and to own living things;

2.The patenting of life raises ethical questions regarding the value of human life, notably with the transfer of human gene sequences to other species;

3.Farmers will become dependent on patent holders, primarily big industrial corporations. Monoculture will be reinforced and genetic diversity lost. Traditional animal husbandry will be economically and legally disadvantaged;

4.This legislation will increase pressure to release genetically engineered organisms into the environment, with unknown effects.

ST361 The Green Party would ban the use of bovine growth hormone BST (bovine somatotropin) used to boost milk production. There is no economic justification for the use of this product of genetic engineering. There are risks to the health and welfare of animals which receive it, and its effects on human health are unknown.

ST362 The Green Party accepts that certain aspects of genetic engineering may be benign and may lead to enhanced quality of life, but feels that there is an urgent need for informed public debate on the issues raised because of the economic, environmental and social control aspects of this technology.

ST363 Pending research into the effects of the release of genetically engineered organisms into the environment, the Green Party seeks a moratorium on such releases through agreement between industry, research establishments and government, as well as a ban on importation of such organisms into the UK. (see AR410)

AR410 Patents will not be granted on any animal and strict controls will be introduced to prevent genetic manipulation for profit or curiosity

I have concerns that these particular policies would abolish the use of GM animals and plants in scientific research. For those readers unfamiliar with modern biological research, much work involves the use of cells, bacteria or higher organisms whose DNA has been modified to remove, add or mutate genes.  Researchers regularly exchange these genetically modified organisms between labs, across borders and continents, as science is essentially a collaborative activity.  Preventing the use and exchange of these organisms would effectively end UK based research in the life sciences.  Concerned about this I asked the Green Party to clarify their policy to determine if they really intended to have such a devastating effect on scientific research.  They indicated that they were primarily concerned with the commercial use of GM and acknowledged they hadn’t forseen the consequences of ST363 in particular:

I must admit I don’t know what the purpose of that last part of ST363 is, since clearly there could be importation for research where there is no potential environmental problem, and I can’t see that there is necessarily a problem in the circumstances you describe.

We review our policies from time to time, and maybe we need to take a look at this one!

When pressed further about AR410 in particular, which appears to prevent GM research, and asked if they intended to consult scientists in the future when reviewing their policies they admitted that ‘perhaps [they] need to’.

I was astonished that a political party expected, including by themselves, to substantially gain from voter disillusionment with the mainstream Labour Party had not thought through the consequences of their science policies in any meaningful way nor appear to have consulted with experts.

Perhaps the Greens are betraying their political and intellectual immaturity, after all they have not been subject to the same media scrutiny as the main UK parties. This is a shame, as it now looks like they will benefit and be put in a position of relative legislative power with policies that fall apart under the slightest scrutiny.  Either their policies are going to be rapidly revealed as being ridiculous and they will become a laughingstock or worse,  they are listened to and wreck EU science.   A vote for Green is a vote against scientific research and for that reason they will not have my vote.

[BPSDB]

Harry van der Zee & homeopathy in the developing world

The Voice of Young Science (VoYS) have published a letter condemning a homeopathy conference, ‘Homeopathy for Developing Countries’, organised by Harry van der Zee and featuring blog regular Jeremy Sherr, in the Netherlands on the 6th June.  VoYS point out that:

Many people in developing countries urgently need access to evidence-based medical information and to the most effective means of treating these dangerous diseases. The promotion of homeopathy as effective or cheaper makes this difficult task even harder. It puts lives at risk, undermines conventional medicine and spreads misinformation.

VoYS will be shocked to read about the latest article from van der Zee in the online journal Interhomeopathy about his Amma project.  The Amma project is based on the belief that musical can be embedded with ‘resonances’ that can cure AIDS and malaria, this ludicrous idea has been presented at the Society of Homeopaths (SoH) conference in 2007 where it attracted considerable condemnation.  Van der Zee and his supporters have ignored this criticism and have now taken their ideas to the developing world.

I’m in Kenya and am just back from my second trip to Congo and Burundi. I cannot hide my excitement about the results I’ve seen there, nor do I wish to. Potentially this Amma concept can grow very fast as the investment in terms of time and funds to implement it in a clinic is minimal. The clinic in Congo is already planning to start mobile clinics for villages and to open more clinics in larger communities. Connections have been made from Burundi to Tanzania and Rwanda to also start clinics there. Among the nurses the interest to know more about homeopathy grows and a program with advanced courses to learn to also use classical homeopathy for all those cases where a genus epidemicus approach is insufficient will hopefully follow soon.

This, like Jeremy Sherr’s activities in Tanzania, is utterly abhorrent, immoral and profoundly unethical.  VoYS are right to draw attention to the madness of homeopaths whose belief in their abilities is evangelical rather than rational, a triumph of faith over reason and morality.

[BPSDB]

Chiropractor Dr Carl Irwin is wrong to call himself ‘Dr’ and makes untruthful claims say ASA

The Advertising Standards Agency (ASA) have passed judgement on an advertising claim by chiropractor business Dr Carl Irwin and Associates.  Dr Carl made the following claim in his advertising:

Dr Carl Irwin and Associates CHIROPRACTORS. Back, Neck, Shoulder, Arm and Leg Pain, Sports Injury, Joint Problems, IBS, Colic, Learning Difficulties, Cranial Treatment for Mothers and Babies. To discuss any area of your health with our Doctors, call for a FREE Consultation.

This claim was challenged on two points:

1. Dr. Carl Irwin and Associates could substantiate the implied claim that their therapies could successfully treat some of the conditions mentioned, in particular IBS, colic and learning difficulties;

2. the references to “Doctors” and “Dr” misleadingly implied that the chiropractors held general medical qualifications.

Also of interest is the reference to colic as the article by Simon Singh, which he was sued for libel over by the British Chiropractic Association (BCA) claimed that

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.

Carl Irwin is a member of the BCA, both the BCA and Carl think that colic can be treated by a chiropractor.  The ASA think not:

1. Upheld
The ASA acknowledged that manipulative therapies used by suitably qualified practitioners had been shown to be effective in treating back and joint pain and minor sports injuries. We noted the journal abstracts, conference paper reports and article references provided by Dr. Carl in support of the claim to treat IBS, colic and learning difficulties. In relation to the chiropractic treatment of IBS we noted the evidence provided included a 2007 randomised controlled pilot study relating to osteopathy and another randomised controlled study where results involving the treatment of IBS with osteopathy were described as “promising”; we noted, however, that those studies referred to osteopathy, not chiropractic. In relation to the chiropractic treatment of colic, we noted a number of reported un-controlled individual case studies where infants had been treated with chiropractic. We also noted several larger studies, one of which was a  “prospective case study”, another of which was based on “a retrospective uncontrolled questionnaire”, another which was a “pilot study” presented at a conference and a fourth which was a blinded randomised controlled trial that measured the “short-term effect” of spinal manipulation on infantile colic. In relation to the chiropractic treatment of learning difficulties we noted a 2007 literature review of the effects of chiropractic on individuals with learning disabilities and dyslexia in which the reviewers considered that none of the studies met all of their pre-defined methodological criteria.

We considered that, whilst some of the studies indicated that further research was worth pursuing, in particular in relation to the chiropractic relief of colic, we had not seen robust clinical evidence to support the claim that chiropractic could treat IBS, colic and learning difficulties.

On these points the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.1 (Health and Beauty Products and Therapies).

The ASA also upheld part 2 of the complaint:

2. Upheld
We welcomed Dr. Carl’s assurance that the practice would no longer refer to its chiropractors as doctors in their future advertising to avoid misleading readers.

On this point the ad breached CAP Code clause 7.1 (Truthfulness).

and concluded:

The ad must not appear again in its current form. We told Dr. Carl not to refer to the treatment of IBS, colic and learning difficulties in future.

Now the ASA are to be applauded in their judgement and willingness to analyse the evidence submitted as well as their criticism of claims that some may describe as bogus but sadly their remit only extends to advertising not websites or professional claims.  Not a medical doctor Carl describes himself as a Doctor on his website and promotes chiropractic for the treatment of colic.  Given the ASA ruling I think it is fair to say that Carl Irwin is potentially misleading people into thinking he has general medical qualifications and making claims unsupported by clinical evidence.  Also Carl Irwin is promoting homeopathy on his website, a therapy I would argue is incontrovertibly bogus, having no plausible mechanism of action and having being robustly proven not to be better than a placebo.

Carl Irwin is a respectable Chiropractor and BCA member who is promoting bogus treatments. With respect to The Quackometer’s challenge I think I may be getting in touch with Mr Irwin about some of his other claims.

*update*

JackofKent has a skeptical lawyer’s brain point of view on this ruling in which he makes the point that the GCC demand that their members work within ASA guidelines.  He concludes with this point:

[...]it would render odd that the British Chiropractic Association still wishes to litigate in respect of its promotion of chiropractic for the treatment of colic when such a promotion by its members would now seemingly be a breach of their professional obligations…

I suspects the BCA and GCC will use the get out clause that the ruling only applies to one chiropractor and one advert, not the wider chiropractic community.  No professional organisation worth its salt would allow a independent body with no stated professional expertise in chiropracty (IMHO the ASA demonstrate a professional approach to evidence) to pass rulings that would have wide implications for the whole profession without some kind of get out clause.  I hope I’m wrong and that this ruling does have implications for Simon Singh and Judge Eady’s ruling, but I’m assuming a default position of pessimism for now.

However, I would encourage readers of this blog to submit ASA complaints about chiropractors making dubious claims referring to this ruling and the ASA guidelines on chiropractic.  The profession as a whole may be resistant to the ASA, individually I suspect they are not.

[BPSDB]

General Chiropractic Council admit chiropractors may be ‘bogus’

You may be aware that Simon Singh, the science writer and broadcaster, has been a victim of Britain’s odd libel laws and Judge Eady’s creative interpretation of the word bogus over an article he wrote for The Guardian.  Outstanding legal pillar of the sceptical community and blogger JackofKent describes Eady’s interpretation of bogus as follows:

The word “bogus” meant deliberate and targeted dishonesty. So it did not mean that chiropractic for the six named children’s ailments (including asthma) was simply wrong, or that it was contrary to established medical practice or research, or even that it completely lacked evidence.

“Bogus” meant a lot more. The judge held that by the mere use of the word “bogus” Simon Singh was stating that, as a matter of fact, the [British Chiropractic Association] BCA were being consciously dishonest in promoting chiropractic for those children’s ailments.

JackofKent continues:

The ruling means that, as it stands, Simon Singh would have to prove at full trial that the BCA were being deliberately dishonest. This is not only extremely difficult but it was undoubtedly not Simon Singh’s view in the first place. The BCA, as with many CAM practitioners, may well be deluded, irresponsible, and sometimes rather dangerous; but calling their promoted treatments “bogus” was not an express statement of their conscious dishonesty.

Interestingly it appears the General Chiropractic Council (GCC), regulators of the profession, have used the word bogus to describe some practitioners, their 2003/4 report begins:

The General Chiropractic Council (GCC) has spent a year working hard,maintaining momentum and keeping focused. Like all health regulators the GCC has a statutory duty to set standards of education,conduct and practice and maintain a register of appropriately qualified and experienced practitioners. It is,in part,through regulatory mechanisms that the public is protected from the bogus,the incompetent,the dangerous and the unprincipled health practitioner. Even though such individuals crop up relatively rarely we must identify and deal with them promptly,openly and firmly.

We can argue over the precise definition of the word bogus and the context the GCC used it in but it is certainly a term chiropractors have used self-critically, thus acknowledging its validity as a descriptive term for at least some chiropractors.

So how many bogus chiropractors are out there?  Well thanks to the Quackometer on the 5th of June we may just find out, so if you know a bogus chiropractor then tell the Quackometer.  After all the GCC admit they exist.

*update*

Posted something on an ASA judgment on a chiropractor’s claims today.

[BPSDB]

Health at every size – comfortable eating and comfortable lies

In recent weeks I have become aware of the beginings of a popular movement asserting that obesity is not a healthcare problem.  This article will be the first in a likely irregular series looking at some aspects of this movement.

Last week the Guardian ran an opinion piece by a dietician by the name of Lucy Aphramor.  Ms Aphramor was promoting the Health At Every Size (HAES) philosophy;

HAES promotes tested and achievable ways to optimise health for individuals and populations. It does this at an individual level by focusing on eating, activity and body acceptance. Of course, food and exercise are old targets in the health promoter’s arsenal, and psychological factors influencing dieting behaviours are well-known. So what’s new? The crucial difference is that HAES emphasises the benefits of sound nutrition, active living and body confidence as ends in themselves, not as a route to weight management.

There does not seem to be anything controversial about this statement, bit wishy washy maybe, bit idealistic, ’sound nutrition’ may be a shibboleth of the alternative health world but its use here may be coincidental, nothing here to challenge conventional health notions.  But things begin to take a turn to the strange as the article continues:

Adopting a HAES approach may or may not result in a weight change, but that’s not the point. The point is that HAES improves health outcomes long-term and dieting doesn’t. That makes HAES the ethical, effective choice.

The evidence for favouring HAES over weight-loss interventions is strong. First, as has been documented in detail in several books, including The Diet Myth by Paul Campos and The Obesity Epidemic by Michael Gard and Jan Wright, the common obesity scaremongering in the media greatly exaggerates the risks.

It is hard to find a review of The Diet Myth, written by a law professor, by a suitably qualified health professional but The Obesity Epidemic has been criticised by Morgan Downey of the American Obesity Association:

It isn’t hard to find researchers who offer global prescriptions to control body weight; it isn’t hard to find press accounts which hype this or that discovery or new information and it isn’t hard to find dubious or misguided policy prescriptions. But the authors’ real target is science itself. They feel that overweight and obesity just can’t be viewed as a science at all and that biology, physics, have not been helpful and will not be helpful in the future. A big part of their gripe is the energy in/energy out formula just doesn’t seem to work consistently in obesity studies.

In fact, a number of the authors’ insights and observations should cause some serious thinking. But it is curious to note that, although the authors are university professors and although they must cite close to a thousand studies, there is not, as I can read it, one reference to the discovery of leptin, much less the influences of the host of neuropeptides, hormones and other neuroendocrine effects of adipose tissue. One must ask, “In all this research, did they never come across the information about grehlin, PYY 3-36, and other such influencers? If they did come across them, why not reference all that is going on? Where is any analysis, or even mention, of the effects of bariatric surgery on the understanding of the disease process we call obesity?

It seems, judging by the amazon blurbs and reviews, these books offer a sociological analysis of obesity that either ignores science or regards it as irrelevant.  I haven’t read these books and don’t intend to critique them here, however, when an argument is presented to public opinion, without academic references and apparently anti-science, by non-experts it should be regarded as weak evidence in any argument. Unfortunately Ms Aphramor seems to regard it as being fairly robust.  The next part of her article does confirm that she might not be approaching the evidence base impartially:

whatever the risks of a particular weight, the scientific evidence is clear: for the vast majority of people, there is no known safe way to obtain significant weight changes and maintain them in the long-term. Dieting puts bodies in emergency starvation mode and, just as it is difficult to hold your breath for a long time, it is difficult to willingly undereat; your body will make you eat, just as it will make you breathe, in order to survive. The evidence shows that weight lost from dieting is almost always regained within a few years, often accompanied by a few more pounds. Weight loss pills (at least, those that haven’t been found unsafe yet) result in a few pounds lost, but only while you continue them. Even those who undergo the risks of weight-loss surgery find that much of the weight lost is regained in the long term. On the other hand, many naturally thin people cannot manage to gain weight for sustained periods either, no matter how much they try to eat.

This is a rather controversial statement and provoked this response from hospitaldietician in the comments to the Guardian article:

Firstly, all weight loss results in loss of both body fat and lean body mass, predominantly muscle, as the remodelled habitus requires less muscle mass, and energy expended, to move. As muscle tissue has a high metabolic demand, preservation also helps offset some of the reduction in energy expenditure associated wth its loss. Research shows that including exercise from 6-8 weeks into a diet (lets not embrace everything at once, if we want sustained acceptance) helps preserve muscle bulk and expend more energy for its duration – a double whammy of benefit for long term weight control.

We Dietitians must take care not to misrepresent the real issues related to obesity – namely its social, economic, psychological and physiological aspects. Yes, Aphramor is correct to say perhaps we are too obsessed with the ideal BMI and that lifestyle, or indeed waist size, may give us more sophisticated assessment of the impact of extra avoirdupois – in approximately 10-20 years or so when our current diet + lifestyle declares itself.

But current knowledge demonstrates that the percentage of the population with diabetes, hypercholesterolaemia, and hypertension increase with incremental increases in BMI.

[...]

Yes, there is great controversy as to whether a BMI of 27 should be an acceptable cut-off point for health risk rather than the current value of 25. However, to imply that it is possible to have good health pushing a BMI of , say, 40, to appease those who throw in a bit of walking and broccoli with their 3000kcal diet is clinically irrational – and not one that should be entertained by dietitians whose clients are in denial about their weight and health risk. Obesity ostracises its carriers, serving as a visual indicator to others of an individuals dietary habits, and perpetuates low self-esteem.

What is important, especially for the morbidly obese, is to root out the cause of ‘whats eating them’. Inability to address the psychological reasons for such extreme body habitus will of course lead to Aphamor’s self-fulfilling prophecy of the ultimate failure of any weight reducing diet.

Finally, longstanding weight loss requires constant vigilance, but the powerful improvement in self-esteem is sufficient for many to maintain their new shape – despite Aphamor’s assertions. The National Weight Control Registry (http://www.nwcr.ws/Research/default.htm) describes a common theme for those with successful long term weight loss that can be summarised thus: a modest calorie diet (usually around 1400kcal a day) and regular, modest exercise (up to an hour a day of walking etc).

For some obese individuals, focussing on a ‘healthy lifestyle’ may be the single step that starts the journey towards a healthier weight and lifestyle. To suggest that this single step is enough for a morbidly obese individual to achieve health is wrong – clinically and morally.
Empathy should not deter us from presenting the clinical evidence of health risks to our clients.

This comment is consistent with the advice and references provided by the British Dietetic Association (BDA) on weight loss.  While it is interesting that a BDA regulated dietician, Ms Aphramor, can feel compelled to offer advice that apparently goes against the scientific consensus and who may be in breach of the HPC proficiency standards* and standards of conduct** for dieticians that is not my biggest concern.  Ms Aphramor has set up a NHS social enterprise, in conjunction with HAES UK, to promote her ideas.  NHS social enterprises are defined as “organisations that are run along business lines, but where any profits are reinvested into the community or into service developments.  Encouraging social enterprise in health and social care is a key part of the patient led reforms.”.

It appears that these reforms have led to a dietician prepared to step outside of her evidence base to create an enterprise offering easy but wrong solutions to vulnerable people.  Presumably the government did not intend ‘patient led reforms’ to lead to easy but inaccurate answers to hard questions and allow populist anti-evidence enterprises but in this case that seems to have happened.

In my next post on this issue I will take a more in depth look at the HAES movement and how they present their ideas to the public.

Thanks to hospitaldietician for their comments.

*

2.2b

- be able to choose the most appropriate strategy to influence nutritional behaviour and choice
- be able to undertake and explain dietetic treatment having regard to current knowledge and evidence based practice

**You must act in the best interests of service users

You are personally responsible for making sure that you promote and protect the best interests of your service users. You must respect and take account of these factors when providing care or
a service‘ and must not abuse the relationship you have with a service user. You must not allow your views about a service users sex‘ age‘ colour‘ race‘ disability‘ sexuality‘ social or economic status‘ lifestyle‘ culture‘ religion or beliefs to affect the way you treat them or the professional advice you give. You must treat service users with respect and dignity. If you are providing care‘ you must work in partnership with your service users and involve them in their care as appropriate.
You must not do anything‘ or allow someone else to do anything‘ that you have good reason to believe will put the health or safety of a service user in danger. This includes both your own actions and those of other people. You should take appropriate action to protect the rights of children and vulnerable adults if you believe they are at risk‘ including following national and local policies.
You are responsible for your professional conduct‘ any care or advice you provide‘ and any failure to act. You are responsible for the appropriateness of your decision to delegate a task. You must be able to justify your decisions if asked to.
You must protect service users if you believe that any situation puts them in danger. This includes the conduct‘ performance or health of a colleague. The safety of service users must come before any personal or professional loyalties at all times. As soon as you become aware of a situation that puts a service user in danger‘ you should discuss the matter with a senior colleague or another appropriate person.

[BPSDB]

The latest deceit from Jeremy Sherr

Jeremy Sherr, the homeopath conducting unethical treatments in Tanzania, made the claim on his blog that:

When I was in South Africa 5 years ago, we had designed a very complex trial together with the Nelson Mandela hospital in Durban.

Well blogger Warhelmet, whose comments here are always appreciated, has contacted the Nelson Mandela hospital and obtained this reply:

Please note that Mr Jeremy Sherr has no association with the University of KwaZulu-Natal and that its Nelson R Mandela School of Medicine has not conducted any research with Mr Sherr.

Looks like another lie to add to the litany of Mr Sherr’s misdeeds.  In summary Mr Sherr has:

1. claimed the support of the Muhumbili University of Health Sciences in Dar Es Salaam, Tanzania.  This is not true.
2. claimed the support of the Department of Integrative Medicine at the University of Maryland, USA. This is not true.
3. shown disregard for established notions of medical ethics.
4. may be in breach of Tanzanian law
5. caused the Society of Homeopaths (SoH) to lie on his behalf

The Homeopathic Action Trust (HAT), the SoH affiliated charity and Sherr’s funders, have had concerns about Mr Sherr put to them.  They refused to take action.

Mr Sherr remains fairly blase about all the allegations raised against him, dismissing all concerns as the activities of “a close group of the bloggers’ friends swimming around in their own swill“.

It is worth remembering that Mr Sherr is a highly respected homeopath whose teaching are admired by many other homeopaths and whose Dynamis school teaches many students.  In many ways Mr Sherr is one of the most respected members of his profession.  No homeopath has criticised Mr Sherr on this blog, they endorse what he does.  Mr Sherr’s failings are the failings of the homeopathic profession.

[BPSDB]

A response to Simon Jenkins

This article represents an attempt to write something for a general lay audience who might not have an interest in science as such, but who read opinions presented in the press.  Let me know your thoughts…

Simon Jenkins is rather missing the point in his criticisms of the WHO and scientists.  It is only because of the vast amounts of public and private funds spent on science and engineering that we can understand the causes of and the cures for influenza.

We now have at our fingertips a huge array of tools and technology that allow us to track and follow this outbreak of swine flu as it spreads and evolves.

Using NCBI and the Influenza Genome Sequencing Project I can understand that the virus consists of three layers; an envelope surrounding a matrix surrounding the genetic code at is centre.  I can see the genes encoding the proteins that make these structures, I can see the proteins, their shape and how they interact with each other to form the virion particle.  I can see how the virus infects cells, what molecular machines of its host it co-opts to replicate, and how it is broken down and reassembled when it reproduces.

Using data published by the CDC I can take the protein sequences from cases of the flu in America compare them with each other, see that there are at least three variants of the HA protein in the community and that these variants are sometimes found in the same geographical location, suggesting that these strains are widespread in the original populations.  I know these variants are proof that the virus is evolving, changing and spreading in response to selective pressure. I know that the HA protein is on the surface of the virus and is recognised by the immune system and used to create vaccines to target the virus.  I know that having multiple HA variants complicates the process of making the vaccine as you need to make sure your vaccine covers as much of the virus population as possible

I can do this because of the work of dozens of Nobel Prize winners, thousands of scientists, millions of hours of research and billions of dollars of funding.   I can do this sitting at my desk during my lunch break.

Simon Jenkins may consider it a waste of money to understand how a virus is transmitted, moves into a cell, replicates, evades immune systems and spreads at a level ranging from individual molecules in a genetic sequence to whole organisms and populations.  He may consider it a waste of money to understand how its effects can be measured, assessed, modified and ultimately prevented.  But I don’t and neither do the WHO and the scientists who spend much more time than I do on my lunch break understanding influenza and the risks it poses.

If we do not understand a disease we cannot prevent it.  The decline in deaths from influenza since the millions killed by Spanish and Asian flu is largely because of science.  If we wish to maintain this decline we must continue to fund research into influenza.

[BPSDB]