Solidarity

My apologies for the long delay in posting and the dearth of new material on this post. All I can do is assure you that I am still alive, but merely very busy with my PhD and a publication... Today sciencey and not so sciencey blogs across the web are re-publishing an article by Simon Singh about the many dubious claims of chiropractors and the British Chiropractic Association in particular. I have made reference to some of the poorly-supported claims of the BCA in a previous blog entry. I've also discussed how scientists go about refuting dubious claims. Science is an adversarial system in which our claims and the evidence upon which they are based are subjected to close scrutiny and, if they appear weak, are attacked. We debate, we refute with contradictory evidence, we put forward alternative explanations for the observable facts. We do not litigate, because litigation silences a scientific debate and transfers it into a courtroom so that some lawyers can have a financially ruinous legal debate.

But the BCA sees things differently. When last year Simon Singh pointed out how weak the evidence in support of chiropractic really is, the BCA reacted not with scientific evidence, nor logical argument. They sued him. That action is now ongoing and has been commented on by Bad Science. For science to progress, debate must be free and open and won on the basis of evidence, not legal funds. This is especially important when it comes to health, because when debate about medical science is stifled, bad practices persist and the outcome is suffering and death. Whether chiropractic is effective and safe will never be determined by a judge. If any of this bothers you sufficiently, the British organisation Sense About Science have a petition you can sign.

The original Singh article (modified to avoid the BCA's litigation bat) is reproduced below, as it has been reproduced by Sharon at The Voyage, Pharyngula and many other blogs. Feel free to refute it with scientific evidence!

Beware the spinal trap

Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results - and can even be lethal, says Simon Singh.

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that "99% of all diseases are caused by displaced vertebrae". In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

In fact, Palmer's first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying - even though there is not a jot of evidence.

I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world's first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: "Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck."

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.

If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

The Streisand Effect

The Jeni Barnett MMR story really has longer legs than many of us sciencey bloggers had hoped. A week after Barnett rehashed every cliché in the anti-vaccination handbook over roughly 40 minutes of hysterical melodrama, the subsequent attempts by both Barnett and her radio station LBC to silence Ben Goldacre's perfectly appropriate criticisms have exploded hilariously in what is called The Streisand Effect. Only the Bad Science followers were paying attention up until the point when LBC's lawyers forced Ben to remove a (rather long) clip of the entire MMR segment of the show in what was a rather dubious and aggressive copyright infringement claim. The Sciencey Blogsphere Collective as not amused. The clip was rapidly copied and redistributed across the interenet, effectively becoming entirely untouchable. Blogs everywhere began to report angrily on the incident and the feeling was almost universally in favour of Ben.

In an attempt to appear open to debate, Barnett's Blog (which rather scathingly dismissed one of her most polite pro-MMR callers as "viscious") called for comments. And the comments came. 121 comments, mostly annoyed but polite attempts to explain to Jeni why MMR is safe and important for public health. A follow-on post by Barnett sneered at the "Bad Scientists" and their "sarcasm". This post prompted a further 81 comments, again the vast majority being critical of Barnett's poorly-informed and irresponsbible stance on MMR.

More blogs reported, more segments of the radio programme were posted, this time in fragments too small and too many to be silenced by questionable copyright infringment claims. Transcripts appeared. PZ Myers rallied his atheist army behind the pro-MMR standard. The Times online noticed the story, and weighed in to defend Ben Goldacre. And, in a quite stunning moment, the great Stephen Fry called for Goldacre to be supported.

Perhaps understandably, Ben's website crashed several times under the weight of visits and messages of near-universal support. Perhaps panicked, Barnett deleted all 200 or so of the critical messages from her own blog and has attempted to move on. No meaningful apology. No recognition of the continuing damage this evidence-free nonsense has done to public health in the UK and Ireland. And of course, no glimmer of having realised that everything she and LBC have done so far, including this, is just making things worse for her and her employers.

For those interested, the deleted blog comments are available at the excellent Quackometer blog.

MMR is safe. Tell your friends.

Bad Science writer Ben Goldacre recently reported on a stunningly ignorant radio broadcast by Jeni Barnett perpetuating the MMR vaccine scare. Ten years after a peer-reviewed paper didn't say there's a connection between MMR and autism but one of the authors told the media that it did, we're still going in circles. We can point fingers in all sorts of directions, including at ourselves, but the data has shown time and again that MMR is safe.

Ben posted the radio slot up to demonstrate that he was not cherrypicking the most stupid parts just to make Jeni look bad. But apparently this is legally not okay and so, because scientific debate has long ceased to matter in the MMR scare, the lawyers swooped in. Personally, I don't think any of us should allow fear to prevail when the cost is so great. The MMR scare is based on crap science and it's putting kids at risk. It has to stop.

Discuss it on Bad Science (there may even be some links to the radio programme): http://www.badscience.net/

On Jeni Barnett's blog: http://www.jenibarnett.com/2009/02/mmr_and_me.php

Update 16:52: Coincidentally, the BBC today announced that Measles cases rose yet again for the third year running. The cause is the reduction in MMR uptake and the result is going to be deaths. Not many deaths, but some.

Update 08 February 2009: And evidence has just emerged that the man behind the scare, Dr. Wakefield, falsified some of the original data showing a temporal association between MMR and autism. Far from there being even that correlation, it appears that some of the kids were showing documented autism characteristics prior to MMR vaccination and others displayed them much much later than was stated in Wakefield et al. (1998).

Things Happen After Event Shock

The Daily Mail have decided to have a go at MMR again as pointed out by Ben Goldacre at Bad Science. A child has fallen terribly ill "six months after MMR jab". Ten years after Andrew Wakefield speculated himself into the headlines by suggesting a link between MMR and autism (in a press-release mind, not in a research paper), this misguided rubbish is still being presented as "science news". Actually, most of the papers now seem to reject the link and are thus in the business of demonizing Wakefield himself, as if they had nothing to do with the scare. But the Daily Mail is apparently not quite ready to take even that ass-covering step. They cite the 1998 Wakefield paper (it was a press release that actually made the claims) and I have responded, though I wonder if it will be published.

Daily Mail, please read the 1998 paper by Wakefield et al. It does not suggest anything more than a temporal connection between the MMR vaccination and the onset of a symptom associated with autism (colitis) that's a long way from even suggesting a possible connection between MMR and autism. Wakefield decided to make that particular suggestion directly to the press, perhaps because the evidence did not support him and he knew it would not be published. More tellingly, ten of his his co-authors on the 1998 paper retracted their support for that claim.
So here we have another temporal association. Thing Y has happened after thing X. And so we must assume that X caused Y, right? Rubbish. I'd imagine a whole load of things happened before this poor kid fell ill.

At this point I ran out of words in the little submission box, so I'll conclude as I would have liked.

The child doubtlessly slept, ate breakfast and breathed constantly just prior to falling ill. So far as we can actually gather from the evidence here, almost anything could have "caused" this tragedy. The likeliest explanation though, is that it was nothing we could have predicted. You write that the child had previously suffered brain damage due to a Herpes Simplex infection at the age of two weeks. Anyone who has had coldsores will know that re-activation of that virus (it never leaves us) is not a predictable event and it has never been causally linked to events such as vaccination, as far as I'm aware.

To imply that MMR was responsible for this sad event is deeply irresponsible journalism and it will doubtlessly further the anti-vaccination movement and lead to more sick kids, and probably more deaths from measles- a disease that was nearly extinct in Europe before this totally unfounded scare.

Update 23 Jan 2009: Predictably enough, my comment has not appeared on the Daily Mail article. Nor have any at all, for that matter. Given that the Goldacre Evidence Army was alerted, that seems just a little suspect to me...

Science Says: Popular Science “Will Give You Cancer”

"Digressions, objections, delight in mockery, carefree mistrust are signs of health; everything unconditional belongs in pathology." -Nietzsche

How often do we pick up a newspaper to find that science has yet again warned us of the dangers of something we all like doing? Power lines cause cancer. Coffee causes strokes. Wait no, it protects against heart attacks. So does wine. But it causes liver disease. Several weeks later, it’ll be something else. Fear it. What passes for science news in the mainstream media, be it highbrow or tabloid is often understandably simplified. Maybe it is too simplified, but what is perhaps of more concern is just where this science is coming from, and whether the editors of our beloved media outlets have sufficient knowledge of the workings of science to make good calls on what is likely to represent real findings.

Take the recent (ish) example cited by Ben Goldacre in his column, Bad Science. It all started when the British newspaper the Sunday Express ran with a headline that said:

Suicides “Linked to Mobile Phone Masts”

This front page article revisited the recent epidemic of suicides in Britain, citing the opinion of a certain doctor “who sits on a government advisory committee on mobile radiation” and who has apparently discovered a link between mobile phone deflector masts and depression. The opinion was presented as a revolutionary scientific finding and doubtlessly caused many people great concern. Ever sceptical, Bad Science found out that said scientist is not part of a government advisory committee but of an independent group which interacts with the British department of health via a mediation group. They’re quite far removed from the government and have no official standing. They further found that said scientist had not published his findings via the conventional route and that the data was not readily available. To a scientist, this sort of evasiveness sets off major alarm bells. And they were justified in this case. It emerged that the same scientist has previously made the claim that AIDS is not caused by the HIV virus but by electromagnetic radiation. In scientific circles, this is roughly equivalent to holocaust denial. Not very coincidentally, this claim looks very much like the claims he is now making regarding depression in the Sunday Express. This smacks of an agenda, and an agenda was indeed found. The “scientist” has numerous books available to buy online regarding the dangers of electromagnetic radiation and the healing power of magnets. Magnet healing kits may also be purchased from him, albeit with no explicit (or legally-binding) claims of having any sort of healing power at all. To put it bluntly, The Sunday Express have given their front page to the science world’s version of Delboy.

There’s far more to the story but Ben Goldacre explains in much greater depth and with greater eloquence than I could. His website comes highly recommended.

What should the non-scientist reader believe these days? To my mind, the best way for the average Joe to approach mainstream science reporting (and all popular science in print or on TV) is with scepticism and basic knowledge of how scientific findings are published and validated. So let’s look at that process. Please? I’ve even provided a flow chart as a visual aid! See, the mainstream press is represented by a small explosion which I hope makes the flow chart exciting.

So, scientific research is conducted all over the place. It is done to varying standards and with varying bias or agenda. For a recap on how proper research is conducted check out my previous posting, First Assumptions. This research is submitted to science journals. These are like ultra specialist magazines, and they mostly will only publish raw science, fresh from the lab. Scientists don’t get paid for this. It’s a privilege to be accepted. In order for that to happen, the work has to pass through “peer review”. This means that the work is assessed by an independent group of scientists in the appropriate field. Every figure, graph and photo is scrutinised. Every turn of phrase dismantled. It’s rather like sending your work to a whole group of Simon Cowells. A lot of research gets rejected out of hand or must be brought up to scratch. Mean things are said, feelings are hurt. The best stuff, the most solid stuff, gets into the journals. Unless you are a scientist or an extreme enthusiast, don’t even think of trying to read these journals. The boredom alone may actually make you die.

If your material is particularly hot, it may well feature as a part of a review paper. These are articles that the journals publish in an attempt to summarise the current cutting-edge of a given field for easier reading. “Easier” being very much a relative word. These reviews are only likely to maim the average reader via boredom and an unforgiving learning curve.

If the research has broad appeal to the scientific community as a whole, it may get picked up by the specialist press. Publications such as Focus, Scientific American or New Scientist cater for scientists who like to read news from other fields. The Biologista, for example is a life scientist who also happens to enjoy reading about robots, dinosaurs and jetpacks. New Scientist provides, and it has pictures.

Finally, the very most relevant and exciting research with the broadest appeal possible reaches the mainstream press. Many newspapers have science supplements, many websites carry science news and some papers will go so far as to carry science-oriented stories on their front pages at times. Radio programmes will often do a round-up of the most amusing science of the week.

This system, from peer reviews through the journals and finally to the mainstream is how things would ideally work. What actually happened in the case of our Prof. Delboy is that information was passed from research of unknown quality directly to a credulous newspaper. No peer review or quality control. No vetting for relevance or, most importantly, bias or agenda. This happens a lot in the mainstream press when it comes to science. The source material appears tricky, so information is accepted on the basis of authority, rather than evidence. Newspapers rarely cite anything more than a name as a source, but that’s the starting point for critical reading, as Dr. Goldacre has ably demonstrated for us.

You don’t have to go read those tricky journals. You don’t even need to read the specialist magazines, though it helps. Just do a little digging. Google a name and look for connections to industry or lobby groups. If you want to see if a named source publishes their research much, follow the link on this blog to Google Scholar and put their name in the search box. Ask yourself, did this pass through peer review? Most importantly of all, demand more of your news source. Look for multiple opinions in science articles. Look for evidence and look for data. Demand critical coverage. Above all, be a sceptic, but reasonable. Be a scientist in your own right.