Private Eye still believes in Wakefield...

As discussed in my previous post, and many other places all over the internet, the GMC ruling against Andrew Wakefield was damning. But not so much if you write for Private Eye, who have been defending Wakefield for years. So, in the light of the GMC findings that Wakefield behaved unethically, with "callous disregard" for the wellbeing of the children involved, and that parts of his research were fraudulent, is it time for the Eye to admit it was wrong?

Apparently not. In an "In the Back" piece, the Eye had the following to say:

Although the GMC said the hearing was not about vaccination and autism, it is fairly clear that the two and a half years of disciplinary proceedings were to bring the MMR debate to a conclusion. The three doctors were to some degree being accused (and found guilty) of causing a public health scare which led to a fall in vaccination rates, so damaging "herd immunity", particularly with regard to measles.

Nope. They were found guilty of conducting invasive diagnostic procedures, against the children's interests and without ethical approval; of not disclosing serious conflicts of interest; and of presenting false information in the publication of their research (which finally led to the Lancet retracting the paper).

Several parents of the children who featured in the team's original research paper, which was at the centre of the GMC case, stormed out of the hearing in angry protest at the findings - particularly the suggestion that their children's tests were not clinically necessary...They say they would have told the GMC that the treatment they received at the hospital helped their children's symptoms - but they were never called to testify.

Eh? We're not talking about treatment here, we're talking about invasive diagnostic tests. These were done without ethical approval, without the required expertise, and against the interests of the children. Perhaps we should just get rid of ethical approval, as it gets in the way of heroic doctors doing whatever they need to vunerable patients.

And finally:

None of this debate about conduct, however, changes the fact that no subsequent research has supported Wakefield's thesis of a possible link between the MMR vaccine and autism. Nor does it change the fact that despite previous attempts to justify the Eye's coverage at the time, some readers are still deeply critical of the magazine's reporting of the MMR debate between 2001 and 2007, when we wrote about the concerns of Wakefield, the families and their lawyers, and endorsed calls for more research (see Letters).

Well, indeed. So why is the Eye still apparently defending the indefensible? I still buy the Eye, for all the other good that they do, but they've made a mistake over MMR and they ought to be big enough to admit it. They would surely ask the same of any of the politicians and industry figures they regularly lampoon.

It's literature integrity week...

The integrity of the scientific literature is at issue in not one but two news stories this week. Firstly, the 1998 Lancet paper by Andrew Wakefield and several co-authors, which purported to show a link between autism and the MMR vaccination, was retracted [PDF] by the journal. Meanwhile, there is an ongoing brouhaha about a 1990 Nature paper that has some implications for climate change research.

I'm only going to deal with Wakefield here because, you know, I have other things to do. The retraction by the Lancet is really the final nail in the coffin of Wakefield's paper, which has been heavily criticised for numerous reasons. Of the thirteen authors, ten had previously retracted the interpretation that there was any link between autism associated with gastro-intestinal problems and the MMR vaccine. Only Wakefield himself and one P Harvey refused to sign up to this: the remaining author could not be contacted. It has also been known for some time that the methodology of the paper was flawed. So what suddenly changed this week?

For some time the General Medical Council (GMC) has been investigating Wakefield and two colleagues, Simon Murch and John Walker-Smith, over allegations relating to their research on autism. The GMC findings were released on January 28th, and can only be described as devastating. You can find the whole thing here [PDF], or there's a good summary at Respectful Insolence.

The GMC did not look at whether the research findings were right or wrong: rather they looked at the research methodology. Essentially, the major problems were these:

1. Wakefield had an undisclosed conflict of interest, because he was being paid by lawyers whose clients believed their children had been harmed by the MMR vaccine.

2. Wakefield ordered invasive diagnostic tests, including colonoscopies and lumbar punctures, that were unnecessary and not in the children's interests, and he had neither the required ethical approval nor the requisite expertise to order those tests.

3. Wakefield obtained blood samples at his son's birthday party by paying children £5 each. The GMC panel described Wakefield's actions as comprising "callous disregard for the distress and pain the children might suffer".

4. The 12 children were described as having been "consecutively referred", but this was not true.

Heres what the Lancet had to say:

Following the judgment of the UK General Medical Council’s Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al1 are incorrect, contrary to the findings of an earlier investigation.2 In particular, the claims in the original paper that children were “consecutively referred” and that investigations were “approved” by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.

So that's that. The problem with the paper is not that it was wrong; that has been known for some time. In fact, simply being wrong would not be a reason to retract the paper. Science often progresses by building on papers that were not quite right. No, the problem with the Wakefield Lancet paper was that it was fraudulent, unethical and incompetent, as well as being wrong. As a result, the takeup of MMR has fallen below the ~95% level at which herd immunity is maintained, and measels has once again been declared endemic in the UK. That's why you should try to avoid publishing fraudulent and unethical research. We'll let you off if your research is merely wrong, as long as it was honestly and competently wrong.

Wakefield eh, what a hero? Unfortunately, as we'll see in my next post, some people in the most unexpected places still believe in the Cult of Andy...

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.

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 - www.elsevier.com/locate/mehy - 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 http://en.wikipedia.org/wiki/Arvid_Carlsson; Sir Roy Calne http://en.wikipedia.org/wiki/Roy_Calne; Antonio Damasio http://en.wikipedia.org/wiki/Antonio_Damasio and V.S. Ramachandran http://en.wikipedia.org/wiki/Vilayanur_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?

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.

Fighting parliamentary committees...with your mind

You might remember me writing about the Intention Experiment in the past. The Intention Experiment hopes to harness the power of positive thinking to influence events. In one memorable example, they tried to influence the structure of water through the collected brainpower of a large collection of gullible numpties. Despite the experiment having a design likely to massively increase the chance of getting a false positive result, nothing astonishing happened.

Gimpy has now made my day by posting this story about homeopaths concerned that the British parliament's Science and Technology Committee will conclude that there is no evidence in favour of homeopathy. Instead of marshalling the evidence and trying to make a scientific case, the homeopaths are trying an intention experiment to influence the committee in favour of homeopathy.

There's just nothing to add to this: it's shear barking mad lunacy, and you have to think that maybe these people are their own worst enemies.

Tuesday is the wettest day of the week...?

It was a bit disappointing to get back from a week in the field in Sinai, to find my employers at the University of Manchester advertising the Manchester Science Festival with this story. Apparently, Tuesday is the wettest day of the week in Manchester.

Well, every day is rainy in Manchester. Perhaps predictably, if you look at the data this conclusion is based on, you can see that there isn't exactly an astounding difference in rainfall between different days of the week. Certainly, statistically significant differences have not been demonstrated. The research has some interesting things to say about how rainfall patterns seem to have changed over the last 30 years or so: Manchester is somehow managing to get wetter. This is consistent with warmer temperatures, as more water vapour can be moved around when temperatures are higher. This is interesting stuff, and excellent for illustrating local changes in climate for a science festival. So why emphasise that Tuesday is supposedly the wettest day of the week, when the data surely don't convincingly support that? I suppose the university press office thinks that wet Tuesdays are a more interesting story than local climate changes, but I don't think I would agree.

A quick google shows that the story has been picked up by the Express (Why Tuesday is the day you'll most likely need your umbrella) and the Telegraph (Tuesday is the rainiest day), which are clearly based around the press release. I think a better press release might have been headlined "Manchester getting rainier", which is interesting and also has the benefit of being supported by the data.