Regulation, Regulation, Regulation.

February 24th, 2004 by Ben Goldacre in bad science | 1 Comment »

Ben Goldacre
Thursday February 26, 2004
The Guardian

· There are a few alternative therapists out there with plenty of time on their hands to do some extra reading. Reina Chavarria, a faith healer in Los Angeles, was this week sentenced to nine years in jail after her treatment of a man who came to her with eczema: she injected him with a mystery substance, he had a fit and promptly died. Not so much as an “I’m sorry” from Reina, who refused to give $250,000 compensation to the family – from her personal wealth of $1.5m (£800,000) – in return for three years off the sentence. Read the rest of this entry »

A surrogate outcome

February 19th, 2004 by Ben Goldacre in bad science, independent, mail, nutritionists, references | 3 Comments »

Read and search all the Bad Science Columns from the Guardian and more here.

Ben Goldacre
Thursday February 19, 2004
The Guardian

Hold your breath and forgive me: this week things are a tiny bit more complicated than usual. According to the Daily Mail, cod liver oil is “nature’s super drug”. I don’t doubt that for a minute. Although I can’t help remembering that almost every time I read a story like that, and then go and check the original published journal article, it shows nothing of the sort.

But this time I can’t even do that: because the paper has not been published yet. All there is on this research is a press release from Cardiff University. “The findings from this study will be published in a medical journal later this year.” When? Where? Has it passed peer review? Has it in fact been accepted? Was the study any good? I don’t know the answer to any of these questions. There’s no way of knowing.

What I can tell you is that there were only 31 people in the study, which really isn’t very many, but I can’t tell you how significant or meaningful the results were, on this small sample, because they don’t tell us the figures. What I can also tell you, for all Cardiff University’s press release hyperbole about this being unique human in vivo evidence, is that it wasn’t even about real people getting better, or about their pain levels, or range of movement, or how far they could walk. All the study seems to show was a small change in a laboratory measurement of an obscure enzyme, what scientists call a “surrogate outcome”. That’s a hell of a long way from deserving five major stories in national newspapers, and even further from what Michael McCarthy wrote in the Independent: “They’re not yet saying it can enable you to stop a bullet or leap tall buildings, but it’s not far short of that.”

GPs this week will, quite rightly, be inundated with patients asking for advice on cod liver oil. How can they give the right advice? And, in any case, it’s not just a question of being right; how can they give sensible advice to pensioners, who may be almost living on the breadline, about whether to spend what little money they have on these pills? To do that you need a proper paper, with all the data. Because science is about data, and papers, which scientists spend their careers finding flaws in; it isn’t about taking things on faith, or on the word of experts. That, all too painfully, is at the heart of the public’s misperception of science, and of bias in research, and that’s something to be fought, as the House of Lords report on science and the media recommended: by training scientists to deal with the press appropriately.

This article has been followed up on here.

Alternative medicine on the NHS?

February 12th, 2004 by Ben Goldacre in alternative medicine, bad science, brain gym, express, penises | 5 Comments »

Alternative medicine on the NHS?

Ben Goldacre
Thursday February 12, 2004
The Guardian

· Well, last week’s chemicals with rude names certainly tapped a rich seam. There are some species names that Carl Linnaeus would have been proud of. So, it’s hard to imagine the story behind how we ended up with a leiodid beetle “Colon rectum”, let alone the scarab “Enema pan”. Linnaeus himself named a pink-flowered butterfly pea “Clitoria mariana”, presumably after a special friend, as well as calling a stinkhorn “Phallus”. Someone somewhere is a big fan of the Sex Pistols, as well as trilobytes, calling a group of them Arcticalymene viciousi, A rotteni, A jonesi, A cooki & A matlocki, Agra vation (beetle), Lalapa lusa (tiphiid wasp), and back to the 80s with Aha ha (sphecid wasp). Whoever said scientists were boring?

· Meanwhile, the Sunday Express continues fearlessly to rewrite the science books. “Disogenine is an element,” Hilary Douglas says, “that can be turned into cortisone, oestrogen, or progesterone.” You can get it from dried yams. Bear with me. Synthetic chemicals, apparently, are “invasive”, not half as good for you as “natural” progesterone, which she seems to imagine your body could distinguish from the effectively identical progesterone in HRT pills. Vegetables are “very alkali”, which is apparently a good thing because acid sounds bad, I guess. Apparently, these “very alkali” vegetables will have some kind of beneficial effect on the movement of calcium across bone cell membrane. Oestrogen will weaken bones, rather than the other way round…and why do I care? Because this newspaper hangs its lead editorial, demanding funding for expensive alternative therapies on the NHS, on this meandering litany of half-truths and fantastical misunderstandings. The day that serious government health policy is influenced by such works of fantasy…Blair guru Carole Caplin in the Mail on Sunday continues her campaign against EU plans to force alternative therapy peddlers to put proper ingredients labels on its products and get licences for the dangerous ones. Be afraid.

· But, the smiling face of a cheeky kid shines like a ray of sunshine into these dark days: “I’d like to submit the revision advice of my teacher. She claims that because the brain works by transmitting electricity through water, drinking more water will improve mental performance.” Sounds like those www.braingym.org pseudoscientists are taking in gullible teachers again. The joy of science: you don’t have to be big to be clever.

Have TV soaps lost the plot?

February 10th, 2004 by Ben Goldacre in bad science, bbc, scare stories | 4 Comments »

Have TV soaps lost the plot?

Television schedules are packed with hospital dramas and medical storylines. But why do they keep getting it so wrong?

Ben Goldacre
Tuesday February 10, 2004
The Guardian

Ronny has been stabbed. He is rushed to hospital, where the doctors realise he has lost a kidney: his only kidney, in fact. Gasp! He urgently needs an emergency kidney transplant, and only his family can help. “He needs the transplant now!” “Ronny is stable, all he’s gotta do is stay that way until we have the tests…”

I’m biting my nails. But only because I’m worried about just how dodgy EastEnders’ medical advisers can be. Real-life donors are a moral and emotional minefield, so let’s just calm things down a bit. Emergency kidney transplants don’t happen. There is a fantastic machine called a haemofilter, invented a few decades ago, which makes rather a lot of money for Baxter Healthcare. They are available on most intensive therapy units and they mean you can potter along for years with no kidneys at all.

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So what sort of a doctor would make a patient go through a major transplant operation, followed by life-threatening doses of immunosuppressant drugs to stop them rejecting the organ, just after they had been stabbed, when there is a perfectly good way of keeping them alive and well until they are ready for an operation and a donor can be found, gently and appropriately?

Maybe I’m just being picky: after all, it’s hardly the first time television doctors have cocked up, and I am surprised the corridors of Holby City, Casualty, Doctors, and EastEnders aren’t crawling with medical negligence lawyers. I have lost count of the number of times I have seen a baby being waved around in the cold and rushed into neonatal resus before they even bother to dry it off with a towel. Nice try, shame about the hypothermia. Or there was that great life insurance advert, where some old guy is being told there is nothing wrong with his chest x-ray; apart from the large and clearly visible pair of woman’s breasts, which might set off alarm bells in your mind, when looking at a man’s chest film. Or how about that Neighbours episode where they smear electrode jelly on to the defibrillator paddles while charging up, and then rub them together to make sure the stuff is nicely spread around (stand well clear if I were you), before shocking the patient back to life with her oxygen face mask still on.

Intubated patients on intensive care cheerfully holding conversations; surgeons heroically running cardiac arrests while the anaesthetist stands there looking worried (I don’t think so); and I’m sure I saw that Robert Winston get into an MRI scanner once, wearing his glasses (anything made of metal would fly across the room and kill someone).

It is so prevalent that there is even a medics’ drinking game called “Casualty” where you all sit around the telly on a Saturday night, and when some good-looking young doctor sticks up an x-ray the wrong way round, everyone has to stand up and shout “Bollocks!”, and the last one to do it has to down a pint of urine. OK, I made the last bit up.

But is it really so bad? Yes. Kidney transplants, especially from live donors, are a difficult moral and emotional area, and even the BBC has recognised that, running a campaign through Holby City to get more people on the NHS organ donor register. “It’s Tariq’s duty to find out if he can act as a kidney donor…” doesn’t really cover the issues appropriately.

I can understand that they might have needed a clumsy plot device to break the story that Tariq is Ronny’s half brother; but imagine you have been worrying and waiting months and years for a live donor kidney transplant, going through the colossal hassle of being haemofiltered, and then you watch EastEnders. What are you going to think? Here I am waiting patiently, and it must be all these emergency kidney transplants that are bumping me down the list? What are these doctors waiting for? If only I’d been stabbed…

It is hardly an isolated incident. A classic paper in the British Medical Journal gave the first quantitative estimate of the size of the pinch of salt that should be taken when watching soap operas. In an analysis of the deaths in four soap operas over 12 years, they found that the most dangerous job in Britain was not, as previously suspected, a bomb disposal expert, steeplejack, or racing car driver; but being a character in a soap opera. A character in EastEnders was twice as likely to die during an episode as a similar character in Coronation Street, and deaths in soap operas were almost three times as likely to be from violent causes than would be expected from a character’s age and sex. Characters tended to die young, and from a variety of obscure and often violent causes: ranging from the mystery virus in Brookside, which killed three, to a plane crash in Emmerdale, which killed four. The authors recommended protective clothing, and regular counselling for the psychological impact of living in an environment not dissimilar to a war zone.

People have a weird enough view of risk already, and hospitals are scary places. But television even manages to give a distorted view of birth, as well as death. Sarah Clement at Guy’s and St Thomas’s hospital analysed the 92 televised births in one year of television: out of just 92, four babies and one mother died, and another five babies and four mothers experienced life-threatening complications. Labour was portrayed as a quick and unpredictable process, resulting in an unexpected event, such as giving birth in an strange place without a professional in attendance, or without the intended companion present, in a third of the fictional births shown. Most worrying were the low levels of analgesia used during labour: gas and air, opiates, and epidurals were used in just 7%, 3%, and 5% of the births respectively.

I know it is only pretend, but childbirth is scary enough; and there is a plethora of studies showing that television and the media affect people’s perceptions of their own health, and risk, and healthcare, and worse , can change their behaviour. The least we could do is make sure the horror stories are accurate.

What’s in a name?

February 5th, 2004 by Ben Goldacre in bad science, bbc, penises | 4 Comments »

What’s in a name?

Ben Goldacre
Thursday February 5, 2004
The Guardian

· Proper scientists are getting on with the important business of broadening our vocabulary. Call me childish, again, but you might want to check out the unbelievably hardcore “molecules with silly or unusual names” website at the University of Bristol’s chemistry department (bris.ac.uk/Depts/Chemistry/MOTM/silly/sillymols.htm). For yes, there is a molecule called Arsole, the arsenic equivalent of pyrroles. And it’s a ring. Normally I wouldn’t give references to papers, but you might want to read about it in the definitive paper Studies on the Chemistry of the Arsoles, G Markl, and H Hauptmann, J Organomet. Chem, 248 (1983) 269. All very childish. I prefer Cummingtonite, a mineral named after Cummington, Massachussets, where it was first identified. And imagine the look of childlike excitement on the faces of mineralogists in Fuka, Japan, as they proudly emerged from the Fuka mines, bearing the mineral they knew they would be able to get away with calling “Fukalite”. Traumatic acid, erotic acid, Bastadin-5, Welshite, Butanol, Anol, Clitorin, Fuchsite, Carnalite, Ciglitizone, Vaginatin, Kunzite, Dickite, Moronic acid, Spammol, Pubescine and the recently isolated element number 111, which, under the IUPAC temporary naming system, is called unununium, presumably until someone famous dies. Fucitol, I’ve had enough, stop me now.

· Much as we feel obliged to love the BBC these days, they do seem to be making a habit of parroting any old nonsense. Environment correspondent Alex Kirby got very excited about the story of N’kisi the psychic parrot. Like almost every newspaper, he failed to mention the research was performed under the aegis of Rupert Sheldrake, who speculates that animals are guided by unproven “morphic fields” and whose last bout of pet research, on a psychic terrier called Jaytee, turned out to be unrepeatable in a study by Dr Richard Wiseman, published in the British Journal of Psychology. The parrot research was endorsed, pleasingly, by Uri Geller. “About 100 words are needed for half of all reading in English, so if N’kisi could read he would be able to cope with a wide range of material,” says Kirby, failing to realise, perversely for a wordsmith, that just because 100 words made up 47% of the content of the Washington Post in one study (don’t say I never give you original source material) that doesn’t mean you’d be able to make sense of it. But USA Today at least managed to mention that Sheldrake’s work has in the past “been met with scepticism among some scientists”. Only some?