Sunday, 31 January 2010

The Observer ignores the evidence on homeopathy

Homeopathy is in the news once again, following a campaign set up by Merseyside Skeptics in which skeptics took an overdose of homeopathic pills, demonstrating that there's nothing in them other than lactose, and then went to the pub for some non-homeopathic beer. The campaign was mainly aimed at high-street pharmacist Boots, whose professional standards director admitted to the science and technology select committee of the House of Commons that there was no evidence that homeopathy worked, but they were very happy to continue charging people money for it. The campaign, and a forthcoming report of the select committee on whether the NHS should fund homeopathy, gave the Observer an excuse to publish a feature article, in which Anushka Asthana and Robin McKie examine the supposed controversy about whether homeopathy works or not.

Of course, scientifically speaking there is no controversy over homeopathy. It's perfectly clear that there is no scientific reason why it ought to work, and that when it is tested in properly conducted trials it works no better than placebo. I grant you that this probably wouldn't make for a very satisfying Sunday newspaper feature, and it would certainly be rather too short to fill up all of page 30 of the Observer. But you might expect there to be some discussion of the actual evidence. Not really, though. Edzard Ernst gets to say that "I have now published more than 100 papers on homeopathy and I am quite clear about its efficacy: you may as well take a glass of water than a homeopathic medicine". The evidence of Jane Lawrence of the Royal Pharmaceutical Society to the House of Commons select committee on science and technology that "There is no basis for [homeopathic remedies] being effective" is also quoted. But then Cristal Sumner of the British Homeopathic Association gets away with saying "Homeopathy helps patients and is not a placebo effect", despite all the evidence showing exactly the opposite.

This is typical of how the press treats scientific issues; they are presented in a superficially even-handed way, but crucially there is no attempt to weigh the evidence. Again, there is no scientific controversy over homeopathy, but by reading the Observer article you could be forgiven for thinking there was considerable room for doubt.

The worst things about the article, though, are the two inset boxes (these only appear in the printed version of the article, not in the online version, as far as I can tell). The first box is headed "Common Renedies" and lists "Popular homeopathic remedies for sale in Britain", including Arnica for clearing up bruises, and mixed pollen for treating hayfever. As these are homeopathic, they contain no Arnica or pollen, and there is no evidence they do anything except lighten your wallet, but this is not mentioned in the box. The second box is headed "Case Study", and recounts the story of one Helen Llewelyn, who claims that homeopathy helped control her endometriosis. This is an anecdote; it tells us that Llewelyn feels better, but it doesn't tell us anything about why, especially as we know nothing of what real medicines she might have been taking. From this website, it looks as though Llewelyn's case history is rather complex, and she is presently using homeopathy in conjunction with several kinds of real medicine. For medical treatments, you need much better evidence than this to show that they work. In the case of homeopathy, the evidence exists and it shows that homeopathy doesn't work. But there isn't an inset box anywhere that sums up the useful evidence: just one uncontrolled case report.

Given that there is genuinely a debate about whether the NHS should fund homeopathy, it would be good for this debate to be informed by the best currently available evidence. That is exactly what the Observer fails to do: all we get is "he said, she said" appeals to various forms of authority, and an anecdote. No wonder the newspapers are struggling.

Saturday, 16 January 2010

Medical Hypotheses row resurfaces

Last year, publishers Elsevier got into trouble with HIV-AIDS researchers, after Medical Hypotheses (an Elsevier journal) published two papers on the subject of AIDS: one by Peter Duesberg claiming that the AIDS epidemic in South Africa was overhyped, and another by Marco Ruggiero suggesting that the Italian health ministry did not believe that HIV was the sole cause of AIDS (blog posts at Bad Science and Respectful Insolence). The papers were deeply flawed, and were retracted by Elsevier pending an investigation into how they were published. The story has now resurfaced in the Times Higher Education Supplement (THES), because:
Prominent Aids researchers contacted Elsevier to object to the article and wrote to the US National Library of Medicine requesting that Medical Hypotheses be removed from the Medline citation database - an act that would exclude it from the mainstream scientific-communication network.
Elsevier have now convened an expert panel to decide on the future of Medical Hypotheses, with conclusions due by the end of 2010.

In fact, there is no great mystery as to how these flawed papers came to be published. Medical Hypotheses is not peer reviewed: instead, decisions on publication are taken solely by the journal's editor, Prof Bruce Charlton. Articles are often accepted within days, or even hours, of being submitted, suggesting there is little or no quality control on what gets published. Prof Charlton defends this process on two grounds: firstly, that there ought to be some outlet for speculative and bizarre ideas that will not be published by mainstream journals. Secondly, that Medical Hypotheses is a successful and influential journal. Here's what he has to say on the comments following the THES article:
The basic facts are that Medical Hypotheses - - is explicitly and proudly editorially-reviewed (i.e. by me - not peer reviewed); aims to publish radical and revolutionary scientific ideas; and it is objectively a successful journal. It makes a profit, the Thomson ISI Impact Factor is 1.416 (much better than average, and rising), and I know from internal sources that there are half a million papers downloaded per year - which is equivalent download usage to the prestigious Journal of Theoretical Biology. Clearly, in spite or because of our policy to publish bold and sometimes bizarre ideas, Medical Hypotheses plays a significant role in medical science. Fact; not opinion. The editorial advisory board currently includes such respected figures as Nobelist Arvid Carlsson; Sir Roy Calne; Antonio Damasio and V.S. Ramachandran . Past editorial advisors have included Sir Karl Popper and Nobelist Sir James Black. *** There are only two possible legitimate outcomes to the current process. Either: 1. Medical Hypotheses could continue as an influential, profitable and well-known editorially-reviewed journal with a radical mission. Or else: 2. The journal could be closed-down altogether, and the title abolished. But it would obviously not be ethically acceptable to launch a new ‘imposter’ journal - with utterly different editorial aims, procedures and personnel; yet retaining the 34 year established title of Medical Hypotheses.
As I keep saying, the impact factor of a journal tells you nothing about its quality. For example, here are three peer-reviewed pseudojournals that repeatedly publish abject nonsense and pdeudoscience, with their impact factors according to Journal Citation Reports:
  • Homeopathy: 1.041
  • Evidence-based Complementary and Alternative Medicine: 1.954
  • Journal of Alternative and Complementary Medicine: 1.628
The articles in these journals are typically written by quacks, and are cited by other quacks writing in quack journals, giving a high-ish but meaningless impact factor. Perhaps Medical Hypotheses is also highly influential among pseudoscientists?

But the main point here is about radical and controversial hypotheses. I think most people would agree that these have their place in scientific discourse, and there ought to be somewhere to publish them. However, this isn't really what the argument is about. In this case, two fatally flawed papers were published with little or no scrutiny: these papers have potential global health implications. In the case of the Duesberg paper, reviews posted on the Denying AIDS blog show the major problems with the paper. There's a difference between publishing provocative ideas that might inspire new research, and ones that are just demonstrably wrong. While the likes of Peter Duesberg have the right to say what they like, they don't have the right to say it in a MEDLINE-indexed journal. This is not an argument about free speech, it's an argument about the integrity of the scientific literature. There may be a place for journals such as Medical Hypotheses, but there has to be some level of quality control. Otherwise, why should anyone take them seriously?

Monday, 4 January 2010

Bad cycling: New Years Day '10'

Not so much bad science, as bad cycling. Last year I returned to bike racing after more than 10 years away, riding a few club events organised by my club, Stockport Clarion. The triumph of my season was my not-too-bad performance in the club hill climb up the Cat and Fiddle. Since then, I've not really been on the bike too much, because it's dark and cold and I'm a bit of a wuss like that. I did have an ill-fated ride before Christmas, where I fell on a patch of ice just before the Great Stone Road roundabout in Stretford, and then almost got run over by the gritter that was following me. But Stockport Clarion traditionally organises a 10-mile time trial on New Years Day, and I thought it would be a good way to kick-start 2010.

It was an 11am start at Chelford, so I reckoned I had to leave about 9:30. This seemed less and less like a good idea as I headed off into the -4 weather, wearing pretty much every piece of bike kit I own. At least the roads were quiet. There was virtually no wind, but riding at about 15 mph was enough to freeze my hands within a few miles, despite my winter gloves. There was a bloke staggering about and yelling as I went through the edge of Didsbury. Hopefully he was on his way home. There was hardly anyone else about. I rattled through a deserted Alderley Edge and made it to the sign-on about 10:45, just as light snow began to fall. Dunc, the timekeeper, had a good story about the previous year's race, when it had also snowed. Apparently a rider behind him noticed that he was leaving two tyre tracks instead of one: he'd twisted his forks in a crash a few days before.

By the time 11:00 came around, there were still only two riders. It was now -3, and the news was that both Snake Pass and the Cat and Fiddle were closed because of drifting snow. One rider from Poynton had taken one look at the thermometer (-6) and decided to go back to bed. Having come this far, I thought we might as well have a ride anyway. Then the perenially late Will arrived, on a full time-trial machine, to make it three riders.

The Chelford course is a bit of a horror, as time trial courses go. But there are just too many traffic lights around Manchester for a selection of courses, so Chelford is what you get. It's hardly a dragstrip, but not really a sporting course either. It's flattish, narrow and typically busy with fast traffic, but being New Years Day it was relatively quiet. The road surface is pretty heavy and there's a couple of lumps to keep you honest, the main one being the railway bridge in Chelford. That probably doesn't sound too bad, but it's amazing how much effort it costs to maintain speed over the damned thing, with only about a mile to go to the finish.

I started number 2, and within a few hundred yards my feet were frozen. There's a roundabout after about a mile, where Ric the marshal was shivering and pacing about to keep warm, and then the turn is just outside Knutsford. By then I'd already been passed by Will at number 3, and was clearly losing time to Dan at number 1. By the time I got to the turn, I was starting to warm up, but my legs just wouldn't have it over the last 4 miles and I finished in 32:53. That's the slowest '10' I've ever done, a minute slower than the first one I ever did riding as a schoolboy under the banner of Penistone Grammar School. I rode back to the timekeeper's car, and took a drink from my bottle: there was ice in it.

Still, the winning time was 28:39, from a rider who would be doing 24 minute rides in summer, so I couldn't feel too bad. In any case, I didn't have time: to avoid hypothermia, I jumped back on the bike and set off home ASAP.

Hopefully there'll be more bad science in the year ahead (there's certainly no shortage of it about), and perhaps even some good science of my own. Whatever else happens, though, I'm certain that there'll be more bad cycling.