Homeopathic Research Institute’s Head of Clincial research fails to declare conflict of interest
Posted by gimpy on June 11, 2009
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.
Andy Lewis said
The paper is laughable.
No doubt we will have homeopaths citing it as more evidence of effectiveness. But the paper states that the aim of the paper is not to test efficacy but “OBJECTIVES: To assess the feasibility of a Randomised Controlled Trial (RCT) design of usual care compared with usual care plus adjunctive care by a homeopath for patients with Fibromyalgia syndrome (FMS). ”
Any idiot could have told Relton before the trial the answer to that question was “No.” – the design is unblinded and not properly controlled – you will get a false positive.
It really is a pantomime world of science over on planet homeopathy.
gimpy said
There was nothing to stop them having an additional homeopath group where the homeopaths made up their minds on which shaky shaky pills to dispense but patients were then randomly and blindly either given a blank sugar pill or a sugar pill with the appropriate ritual applied. But then that might lead to awkward results…
Andy Lewis said
But in the topsy turvy world of homeopathy Relton must surely know that such careful blinded and individualised trails fail to give positive results for homeopathy.
Whereas shoddy, unblinded, non placebo controlled trials do. Therefore, these trials must be the way to test homeopathy.
gimpy said
Andy, are you really implying that homeopaths might rig trials to mislead people into thinking their pills work? I find that hard to believe, after all homeopaths love to accuse big pharma of this – there is no way they would be so foolish as to adopt the worst excesses of the pharma industry and expose themselves as ranting hypocrites. Would they?
Andy Lewis said
No of course I am not implying deliberate dishonesty. The hallmark of a homeopath is an inability to understand causality. Homeopathy is nothing but a simple post hoc mistake based on a two hundred year old error of induction. If they understood this, thy would not be homeopaths.
Mojo said
“There was nothing to stop them having an additional homeopath group where the homeopaths made up their minds on which shaky shaky pills to dispense but patients were then randomly and blindly either given a blank sugar pill or a sugar pill with the appropriate ritual applied. But then that might lead to awkward results…”
I think I’ve either read or possibly heard in a talk recently that trials of individualised homoeopathy are now running into the problem that homoeopaths are becoming very reluctant to take part (and, of course, you can’t perform a trial of this kind without the cooperation of a homoeopath).
Incidentally, if anyone can let me know where I might have got this from I’d be really grateful, because I’ve been looking for it for a couple of days now…
Tricky Dickie said
That would not surprise me at all. There have now been enough trials to ensure that all agree that fair trials do not work out well for homeopathy. The special pleading why this might be so has now become ‘accepted knowledge’ in homeopathic circles. It’s all quantum thingumy paradigm different for alt med, everyone knows thay!
Lafayette said
This is a flawed trial, so how did it get ethical approval? Why waste people’s time, energy and hope on research that won’t demonstrate anything?
pv said
I swear that homeopathic “research”, just like its chiroquackery counterpart, isn’t done (if that’s the right word) with a view to understanding anything any better. It’s done to provide fluff and filler for marketing – which itself is aimed at people more likely to think a double blind trial is poking someone in both eyes with a stick… twice… and seeing what happens.
It’s also interesting to see how the homeopathic goalposts move with the requirements of the homeopathic market. Homeopathy piggy-backing on real medicine. You know, person has cancer, chemotherapy, radiotherapy and homeopathy. Cancer goes into remission and patient (along with homeopath, credits homeopathy.
As for not declaring an interest, why should honesty start creeping into what is in effect legalised fraud?
Robin said
For those who believe, no proof is necessary. For those who don’t believe, no proof is possible.” – Stuart Chase
Sandy5 said
The quote from S Chase isn’t relevant to the question of homoeopathic efficacy. We already have plenty of evidence that homoeopathy is solely placebo. It is not a matter of believing it works or does not work, it is a matter of assessing the available evidence.
Robin said
your comment only confirms the second part of Stuart Chase’s quote. If you were able to look at the evidence without your resistance and bias you would see it differently.
Derrik said
It isn’t a good idea to look at evidence without resistance or “critical thought” as we like to call it. That way lies madness.
The experiment described above was rubbish. Even if homeopathy works that experiment could not have found evidence for it. The experimental design included a massive confounding factor. Why do you just want to accept every crumb of useless crap that would be consistent with homeopathic phenomena occurring as adding to a pile of evidence. No matter how much crap you get in the pile it remains a pile of crap.
Why not lobby for quality research if your so sure it can be obtained? Don’t whine that it will never convince Gimpy, you don’t have to convince Gimpy you have to convince the British public, policy makers and NICE.
Sandy5 said
@Robin.
The second part of Stuart Chase’s quote is “For those who don’t believe, no proof is possible.”
That is crap. Utter crap. Total crap. All sorts of crap.
The proof required is simple to understand and demonstrate if indeed it is possible to demonstrate. So far the efficacy of homoeopathy has not been demonstrated in any form. Additionally the body of evidence shows definitively that homoeopathy is solely placebo, only placebo and nothing but placebo.
I do not believe due to the evidence available. Show me some evidence and I will “believe” although I think that belief is not a concept related to fact. You can believe in bigfoot, santa or the easter bunny but if your health or life depended on it I think the standard of evidence you would want might differ.
Michael Kingsford Gray said
Then Chase is completely and utterly WRONG.
Show me sufficient valid evidence for homeopathy, and I will believe in it.
Neuroskeptic said
Lafayette – Well, interestingly, the trial’s objective is described as “To assess the feasibility of a Randomised Controlled Trial (RCT) design of usual care compared with usual care plus adjunctive care by a homeopath for patients with Fibromyalgia syndrome (FMS).”
So the stated objective of the trial was not to test homeopathy, but merely to test whether it’s possible to test homeopathy! Except that they then present the results of the trial, which lo and behold are very favorable to homeopathy. In other words they did in fact test homeopathy after all (very badly…) I suspect that these verbal acrobatics might have been for the benefit of ethics boards or peer reviewers -
“Yes it’s a crap trial, but it’s just a pilot to assess the feasibility of doing a real trial… but we’re going to present the results anyway.”
ez said
“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 “…
You always say that if something was found to work it would already have become mainstream.
If the session mentioned in the above quote is so clearly working for people, why is it not adopted in mainstream medicine yet?
notspock said
They often talk about how doctors in the past had virtually no training on how to talk to people. These days they are taught how to be nicer.
You might find that actual MDs that give out herbal or homeopathic remedies (or even cough syrup thats just gloopy sugar) know what they are doing – reassuring chats plus non-functional medicines.
Derrik said
For the sugar pill there is an ethical issue with lying to patients.
In the UK over the last couple of decades there has been substantial effort to reform the doctor-patient relationship so that patients are fully informed about the risks and benefits of treatment and involved in making decisions. Handing out placebo treatment would be deleterious to this relationship.
For the nice chat you have a point. This is an issue of cost for the national health service and as such is a political rather than a medical problem. General practitioners are expensive and most patients only get 10 minute consultations. Perhaps consultations should be longer. Perhaps GP surgeries should have people available to provide the “nice chat”. Whatever the solution, spending NHS money on nonsense is not it.
Neuroskeptic said
The trouble is it’s not clear that it actually does help people. In the context of a clinical trial it leads to “improvements” – generally something like “How ill do you feel on a scale of 1 to 10?” and it reduces that by 3 points or something – but there is no evidence on whether this translates into actually living a better quality of life in the long run.
And there are potential harms of the over-use of placebos as I have written about…
ez said
Well, yes indeed, it would be good to have long term studies, say 5 year follow ups, on EVERY treatment. THere was a report of homeopathic treatments continuing to hold 6 years on, I’m sure you have heard about this, I do not collect references, sorry.
On the other hand I have recently come across reports that some conventional drug for asthma was found effective in a trial that lasted several months (and which was used for its approval), but some follow up research conducted twice the period (sorry, I forget what the period was – 2 months? 6 months?) later all the symptoms were back and most people were back to square one. SO what are we supposed to think if nobody really does conduct long term trials running, say, 5 years or more?
I can tell you that people with hormone problems that I have given homeopthic remedies 8 years ago or so had their hormone readings back to normal within couple of months from starting the treatment, and they all stay with them now. So whether this was placebo or what, it had a lasting effect by all standards…
Chris said
Ez:
Which is why your claims will be duly ignored. So far no one has produced any real evidence that homeopathy works any better than placebo.
ez said
To Chris,
That’s your choice, of course. Please, feel free to ignore what I wrote – I did not claim anything, by the way, all the data are stored in the hospital files of the patients, as obviosuly I do not perform any hormone readings or any other tests myself, it’s the hospital staff who do that.
Wakeupplease said
Pots and Kettles.
http://www.bloomberg.com/apps/news?pid=20601109&sid=aVvfe.v1k_VY
I agree that there is much that is misguided in the world of CAM and that research should be done in a way that satisfies the scientific method.
One of the main issues would seem to the cost of good quality research. How much does a good quality trial cost. One that involves a large number of patients over a long enough period of time. A couple of hundered thousand, a million maybe? Not being an expert in this field i am not sure so maybe one of the experts on here could enlighten me. What is clear is that conventional medicine is positively swimming in money.
As an aside i was listening to the radio where some medical person was going on about research that proves that womens fertility goes down as they get older. WTF is my tax payers money being used to fund some white coat to find out the bleeding obvious. So that is the problem, those on here are all too willing to point out the flaws in a system which to the best of my knowledge has not had anywhere near the level of funding necessary to exmine it accurately, and yet ignore those of the system they avidly promote.
phayes said
“Pots and Kettles.”
How does that work exactly? The pot and the kettle are both black (which we knew already, thanks very much – see badscience.net, (probably) some of Gimpy’s other posts and a zillion similar sources for criticism of Big Pharma’s iniquities). So the shiny pan criticises both the kettle and the pot, and that means it must really be black and probably a pot in disguise too? If you must use fallacious arguments, at least try to use less obviously inappropriate ones!
“What is clear is that conventional medicine is positively swimming in money.”
What a surprise. Hospitals and doctors prefer to buy stuff that works, medical research funders prefer to spend money researching and trialling stuff that has a good chance of working. That said, lots of public money has been spent on testing CAM and there is enough money in the CAM private sector to float whales such as Boiron. But not only does Boiron fund few if any trials, it does not even withdraw specific ‘medicines’ from the market when they are exposed as inefficacious by external research. (Nothing special about Boiron in that respect of course – no doubt Big Pharma would do that sort of thing too if it wasn’t constrained by law).
“WTF is my tax payers money being used to fund some white coat to find out the bleeding obvious.”
You say it’s bleeding obvious but in fact it isn’t (unless you facilely include the entire female lifetime and don’t care about actual levels of fertility and rate(s) of decline within that period). You fail to say what exactly this research was and what it really set out to find, but it’s hardly likely that it was as vague, unquantitative and uninformative as you’ve characterised it.
“to the best of my knowledge has not had anywhere near the level of funding necessary to exmine it accurately”
On the contrary: homeopathy has been massively over-examined. It is known not to work (and has been for a long time) as surely as we know that the earth does not rest on the back of a giant turtle. The fact that precious taxpayers’ money is still being spent on it is truly outrageous, yes.
Warhelmet said
Oh dear. Mrs W and I are having fertility issues. We aren’t alone in this. OK, I can accept that taxpayers may be adverse to funding fertility treatment – cough, we’ll pay for our own, thank you very much – but research? Feh. Sorry Wakeupplease if you don’t understand the importance of fundamental research, but research into this sort of thing doesn’t exist in a vacuum. It’s not just fertility falling with age that it touches upon. It feeds into the whole corpus of knowledge on the reproductive and endocrine systems.
Robin said
Its interesting to read all these skeptics who have no knowledge or experience of homeopathy claiming that it does not work. Its clear that nothing will change the mind of people with such fixed ideas. Homeopaths are actually more expert in understanding the action of placebo than any of you (dont bother with the funny remarks) and over 3 decades of using both homeopathic remedies and placebo I think I am quite good at differentiating between a true healing response and a placebo response. They are usually quite different in character over time.
Can any of you wise people explain to me why my placebo, i.e. somewhat reserved homeopath working in an unimpressive room above a healthfood shop, often works better than the placebo effect of seeing the top medical specialists in the land and taking their high tech treatments?
Most people that come to homeopaths are there because modern medicine has failed them. Despite that a large proportion of them are helped including those pronounced incurable by the doctors. If I can significantly help even 20% of the doctors write offs surely I am doing a good job?
Derrik, as for the need to “convince the British public”, they are on the whole already convinced. Your repeated attempts to dissuade them from trying soemthing that could help them is what is failing. I never canvassed or advertised for patients at all. They come by referral from other satisfied patients. That could only go on for so long in a small town if what I was doing was bogus.
seyahp said
“Its interesting to read all these skeptics who have no knowledge or experience of homeopathy claiming that it does not work. Its clear that nothing will change the mind of people with such fixed ideas. Homeopaths are actually more expert…”
You really have absolutely no idea just how witlessly ironic that is do you?
http://www.sciencebasedmedicine.org/?p=527
“They come by referral from other satisfied patients. That could only go on for so long in a small town if what I was doing was bogus.”
Unlike their ‘remedies’, which can be distinguished one from another only by the latinate names on the labels of their containers, the many fallacies dispensed – ad nauseam – by homeopaths, such as “non sequitur” and “argumentum ad populum”, can be distinguished by form and content too – even when they are mixed up together.
seyahp said
“Its interesting to read all these skeptics who have no knowledge or experience of homeopathy claiming that it does not work. Its clear that nothing will change the mind of people with such fixed ideas. Homeopaths are actually more expert…”
You really have absolutely no idea just how witlessly ironic that is do you?
http://www.sciencebasedmedicine.org/?p=527
“They come by referral from other satisfied patients. That could only go on for so long in a small town if what I was doing was bogus.”
Unlike their ‘remedies’, which can be distinguished one from another only by the latinate names on the labels of their containers, the many fallacies dispensed – ad nauseam – by homeopaths, such as “non sequitur” and “argumentum ad populum”, can be distinguished by form and content – even when they are mixed up together.
Derrik said
Robin you say:
“I think I am quite good at differentiating between a true healing response and a placebo response.”
So there is an experiment I’d like to see performed. I’ll lay it out below, I’d be interested to hear what you think of it. After engaging with homeopaths on lots of boards seeing statements like the one I quote from you I wanted to think of an experimental schema that would leave the homeopath in complete control.
The schema I came up with is a sort of DBRCT which tests the capability of the homeopath to identify patients in the placebo or verum group.
It runs as follows:
1. Prospective patients arrive at homeopath as usual. If the illness and proposed treatment are such that the homeopath believes they will be able to tell the difference between verum and placebo they are eligible for the study. If the patient gives informed consent, they are enrolled.
2. The homeopath proscribes a treatment for the patient.
3. The patient goes to the homeopathic pharmacy and is randomly allocated to verum or placebo group.
4. If verum the patient if given the homeopaths prescription.
5. If placebo the patient is given a correctly labelled bottle containing potentised water pills.
6. The patient continues to visit the homeopath regularly. The homeopath may alter the prescription as they feel fit. Verum will then receive the updated prescription, placebo will continue to receive placebo.
7. When the homeopath feel confident in calling which group the patient belongs to they do so.
8. The patient then reverts to normal treatment.
9. When sufficient patients have passed through the process to assure statistical confidence the homeopaths calls and patients true allocation are revealed. If the proportion of correct calls exceeds the pre-determined threshold then, wow, there is something in homeopathy. If not then you’ve all been wasting your time.
This schema does not require any conventional diagnosis or measurement of a specified out come. It is the homeopath alone who makes the call, on any evidence they think is relevant, in a way as unique to each case as they wish.
I don’t expect you to actually do this. I accept it would be too expensive and disruptive for a high street homeopath to do. I would however like to hear what you think of it.
ez said
To Derrik,
there was a study on dogs
“in the March 21 2009 issue of Veterinary Record (Volume 164, Issue 12)”
in which the owners of the dogs were reported to have correctly guessed when their dogs received the verum remedy and placebo remedy, check the article.
wakeuplease said
From what i know of it i believe this is/ was the test that George Vithoulkas was trying to put together in Greece.
Derrik said
Ez.
You have picked yet another “pilot” paper as evidence.
I read this paper a while ago. 20 dogs enter personalised treatment 5 appear to respond. Of these one is euthanized for a condition other than the one for which they were being treated, still wasn’t homeopathy supposed to be treating the whole animal not just one condition? One did get better so was also eliminated, this left just three (3!) dogs for the blinded part of the study. To me, 5 out of 20 appearing to respond to treatment is a resounding negative. Three (3!) participants in a blinded placebo controlled trial is a joke.
Weirdly for the placebo controlled trial each dog was given both homeopathy and placebo in sequence. This does not seem suitable for homeopathy since you are supposed to be treating underlying causes not relieving symptoms, if homeopathy were effective why would a dog relapse when given placebo?
Anyway there were three subjects in this part of the trial. So there are 8 combinations of right (R) and wrong (W) attribution of placebo and homeopathy.
RRR
WRR
RWR
RRW
WWR
WRW
RWW
WWW
So there is a 1 in 8 chance of owners getting this right by chance alone. This is not statistically significant. I suspect that because these owners had previously been exposed to real homeopathic pills and had the opportunity to compare placebo and verum in the blinded phase that they could detect subtle differences in the pills and broke the blind.
This particular author has a history of publishing “pilot” studies with no full studies following them up. The paper you site is another example of the slight of hand in these papers which start of talking about being a pilot study and then report the results as if it where a real study. Failure to follow up pilots with improved pilots or full studies is piss poor science, and an ethical violation. The subjects effort and risk is wasted if it is not part of a continuing research effort.
Lavender said
Is it correct to describe the effect of the “intervention” here as the placebo effect? Seems that the indepth interview could work as a direct psychological intervention (some form of talk thereapy or empathic counselling) with some sugar thrown in on top. As Fibromyalgia may have a pscyh component to it, kind of a sensible intervention even. Point is that it’s not the placebo effect, it’s a treatment effect but not the treatment they meant to be testing.
Neuroskeptic said
“Can any of you wise people explain to me why my placebo, i.e. somewhat reserved homeopath working in an unimpressive room above a healthfood shop, often works better than the placebo effect of seeing the top medical specialists in the land and taking their high tech treatments?”
Because some people – people such as yourself, no offence – believe that it works better?
Robin said
yawn
neuroskeptic said
If you find the truth boring, I can see why you like homeopathy.
AndyD said
On a related note, can someone help me with some arithmetic please?
The wikipedia page for homeopathy carries the claim that there is a 60% chance of finding a molecule of ingredient in a 12C solution (if one mole was used).
This strikes me as quite wrong. Firstly because of the “if one mole was used” requirement (I can’t see that the starting quantities matter, it’s surely all about relationships) and secondly because 12C is 10xAvaogadro so 60% probability sounds extraordinarily high and appears to assume, at the very least, that the molecules would have divided perfectly evenly at every dilution.
I’m sure it’s wrong but can’t convince myself as to why.
If it’s grossly incorrect, then I’d hope someone who knows their stuff could fix it.
Derrik said
It would depend on the volume of the solution
notspock said
What is the molecular weight of the entrails of a duck? (Or the bacterium that causes the
flu, cancer,eczema, rheumatism, tuberculosis, measles). Even if its a fairly simple molecule thats at about 100 – at 100grams per litre is a pretty strong solution to start off with.
I’d have thought that if one was dealing with a nosode and Korsakovian dilution, there is a fair chance of something nasty remaining in the “remedy”.
ie you get a piece of diseased tissue, and you “wash out” the container its in 100’s of times.
Thats about as appealing on having surgery with a scalpel thats been washed quite a lot in cold water after being stuck in a carbuncle.
AndyD said
Sorry, it’s obviously not 10xAvogadro but closer to 1.6xAvogadro. I guess this is why they’ve claimed 60% odds but it still niggles me.
seyahp said
Yes – it’s just a rough general estimate (6×10²³×10⁻²⁴ = 60% so it’s not grossly incorrect). Of course homeopaths don’t even identify their mother tinctures by molecular content and they don’t measure them out by mole and dilute them by precise mixing of n moles with 99n moles of ‘pure’ diluent per step, but I don’t think that statement in the wikipedia article could be usefully much improved except perhaps by putting a “≈” in front of the “60%”.
seyahp said
…and by removing the “if one mole was used” bit too – as you rightly pointed out.
Pete said
Homeopathic Pharmacies in the UK apparently dilute in small vials using approx 4ml of alcohol/water.
To take the example of Natrum Muriaticum or Sodium Chloride:
1 mole of Sodium Chloride weighs approx 60g
To make a 1c on the scale used 0.04g would be disolved in 3.96g of water.
Therefore this 1c solution would be 4ml approx and would contain 0.04/60 moles = 0.0006moles approx of Sodium Chloride.
A 4ml 10c solution would contain 6 x 10-22 moles of Sodium chloride.
considering that to medicate a small eg 5g bottle of pills would according to German or French homeopathic Pharmacopoeia require 0.5% of ‘potency’ or 10c added. This would mean that each homeopathic pill would have < 6 x 10-24 moles of Sodium Chloride per pill.
This implies that conventionally made homeopathic remedies are infinitely dilute beyond Avogradro's number at 10c and not 12c dilution.
Robin said
Derrick I think that would be a good experiment. It would require a large number of patients.
The ones that are easiest to spot as placebo are the ones that get dramatically better very quickly. Placebo is better than homeopathy in that way! Homeopathic cures are more likely to be gradual and lasting. Another charactersistic that differentiates them are patients that are responding to homeopathy are usually relieved of symptoms seemingly unrelated to the chief complaint as well as symtoms they forgot to mention to the homeopath. Further, they quickly forget about a lot of the ex-symptoms they mentioned during the first consultation. There is a lot more to the quality and character of these things than that but it gives you some idea. I would be happy to be part of such a study and am confident I would do well.
I have another idea for a study that would definitely prove that agitated nothingness has a tangible effect if you are interested.
Robin said
Anyone want to hear the story about my dog thriving after being saved by homeopathy from “euthanasia or a certain painful death”? He loves placebo.
No, I didnt think so.
friend of a friend said
I think the fact that there is all this mystery behind homeopathy is just not good for the industry. i fail to see why studies are even created, what is the point if they only serve to cloud judgement on a particular subject.