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.

Bacon Sandwich

I'm pretty busy writing up my work at the moment, hence the long break in posting this month. I'll try to fire out a few short but useful entries over the coming weeks rather than saving it all up for the monolithic posts I usually make.

Every week, some newspaper or another makes us frightened or happy by covering the latest risk data regarding "causes" or "cures" for cancer, stroke, heart disease and the like. Apparently they won't be happy until they've fully catalogued all Things at least once over, and preferably twice with flatly contradictory information. They present us with statements such as "Bacon Sandwiches raise cancer risk by 20%". That would probably put quite a few people off eating bacon sandwiches, but it's not a statistic you'll ever find in a peer-reviewed scientific paper. And there's a good reason for that. This sort of figure is what is called a "relative risk increase". It's calculated by taking the dividing the new risk (with bacon sanswiches) by the normal risk (sans sandwich) and multiplying by 100. We can see the weakness of that way of representing the numbers with an illustration such as this:

The risk of killing yourself with a revolver loaded with only a single bullet in a random chamber is 1 in 6. Put two bullets into two random chambers and the risk is 2 in 6 (or 1 in 3). These are absolute risks as opposed to relative risks. In percentages, the absolute risk is just over 16% with one bullet, but twice that (32%) with two bullets. Now let's do a Daily Mail on it and express this as a relative risk increase. That's a 16% increase over 16%. So by putting in the extra bullet you've just increased your risk of killing yourself when you pull the trigger by 100%. That last number is certainly the scariest, although we must admit that none of these numbers is particularly fun.

But here's where it gets interesting (stop rolling your eyes please). Imagine the risk of catching a fatal dose of the flu is 1 in 10,000,000 for each time you go to work on the train, but is 2 in 10,000,000 if you take the bus. These odds are very much lower than the absolute risks relating to the gun. In percentage terms they sound comfortingly low too (0.00001% increasing to 0.00002%). You're probably not going to base your public transport decision making on these numbers. However when we convert these numbers into a relative risk increase, we get... 100%. A headline that says "Buses Raise Flu Death Risk by 100%" is certainly going to either make you think twice about using the bus, or is going to make you think that those silly boffins are just spoofing (didn't they say buses were better for some reason last week?). You get exactly the same punch in a Daily Mail headline as the gun risk, and yet in reality they're not even vaguely similar.

This week a nice site caught my eye which puts all of that statistical wonder into a fun little web program that allows you to see the various ways in which scientific data can be made more scary. There's all sorts of ways to make a scare story out of a non story, and you can rest assured that most of the newspapers are quite prepared to use them.

Image from Wikipedia released under the terms of the GNU Free Documentation License.

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.

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 Goes Boom: The Large Hadron Collider

Update 10 September 2008: Well, the world is still with us. The LHC has powered up and run a successful one-way test collision. We live to collide another day. The real experiments are due to begin on October 21st so I expect we shall hear more from the panic mongers. But for now, every-day scientists, a funky-looking picture (the first data produced by the LHC).


Author's note 04 September 2008: Beaten to the punch! A geologist friend of mine suggested an article debunking the LHC panic a few weeks ago, but I thought it more appropriate this week. The Short Sharp Science blog (1st September) however, has pretty much pre-empted my own commentary, practically down to the last point. Here's my take anyway.

On the 10th of September, if Dr. Walter L. Wagner is correct, there’s a pretty good chance that the world is going to end. Or at least begin ending. On that day, the scientists at the Large Hadron Collider (LHC for short) will power it up and perform their first experiments. The LHC is a particle collider, a giant ring tube, 27 kilometres in circumference and buried beneath the Swiss countryside at a depth of about 50 to 100 meters. The point of this ring, as the name suggests, is to collide particles. Particles can be atoms, the building blocks of all matter, or even pieces or these. The particles are launched into the ring tube in opposite directions. Large electro magnets keep the particles traveling along the same line inside the ring and ensure that they follow the curve of the ring around to the far side. At the far side, the particles collide. When this happens, the particles effectively explode on a tiny scale, producing new and even smaller particles. This effectively replicates the sorts of collisions that occur between cosmic rays and the upper atmosphere of the Earth.

The collision is timed so that it happens just as the particles enter an enormous eight-storey-tall detector (pictured to the right). There are already many devices like the LHC in the world, and they’ve taught physicists a whole lot about the universe, but the LHC is different. It’s the biggest particle collider to date, and it can throw the particles out with greater energy than any device previously built. In fact, the LHC will propel tiny particles about 1x1025th (that’s 1 with 25 zeros after it) the size of a grain of sugar, with the same energy as a high speed train. The goal of this €5 billion project is to test the current major hypothesis in physics, the Standard Model. This includes the search for a particle that has been predicted to exist by our current understanding of physics, but which has never been observed; the Higgs boson, the particle that is thought to give all matter its “weight” or more correctly, its mass.

If these collisions are so very common in the atmosphere of Earth, why bother with the LHC at all, you might ask? The answer is in that eight-storey tall detector. Not an easy thing to lug around, let alone fly into the atmosphere. And since we can never predict where a particle collision may naturally be about to occur, we would have no chance to move the detector to the correct spot, let alone line it up so that the collision happened exactly at the centre of the detector. The far more sensible option is to bring the particles to us, which is what the LHC is for. If the experiment fails or succeeds, it might well usher in a paradigm shift in physics.

Doomsday

The problem is that some hypotheses about the universe predict that we’ll find something much less pleasant than the Higgs boson in our detector. Amongst the suggested doomsday outcomes of the LHC experiments are the creation of stranglets, magnetic monopoles and, Dr. Wagner’s favourite, mini black holes. It’s unlikely that most people (including me) will know what those first two things are, but pretty much everyone has heard of black holes. And pretty much everyone knows that they are, to put it mildly, A Bad Thing. And it’s black holes that are what Dr. Wagner is warning the world about. If formed, Wagner predicts, such tiny black holes would not be detected at first. They would zoom right through the LHC (they’d be too small to interact with matter) and off into space, at least for a while. Caught in the gravity of Earth, a micro black hole would fall back and right through the planet before flying into space again. This might happen a number of times before the black hole starts to collect matter, and starts to slow down as it does so. Eventually, it would settle down in the core of the Earth. And there, it would literally swallow the planet in just over two years. We would probably figure out that something had gone wrong when the earthquake would start. Things would get very nasty very quickly after that, and it is unlikely that anyone would survive to see the actual imploding death of Earth itself.

Scary stuff, and with that kind of story making the rounds, it’s little wonder that some people are calling for the LHC to be stalled, shut down or destroyed. The tinfoil hat brigade on the internet (conspiracy theorists), are out in force and claiming that the LHC is in fact a weapon to destroy life on Earth. A story that has something to do with aliens seems the most popular motive for such an expensive way to do a job that could be more cheaply and easily performed with a few nuclear warheads.

But let’s take a step back from Crazyland for a moment and take a look at what the scientists who started the controversy are actually saying. They’re not actually claiming that the LHC will cause catastrophe, but rather that it might. Nor are they calling for the dismantling of the LHC, but rather for an injunction to stall experimentation while safety assessments are carried out. Further safety assessments, that is. A major independent safety review already concluded that the LHC was safe in 2003. Another review confirmed this in 2008, and that review was double checked by yet another independent scientific council. Two groups of physicists have also published peer-reviewed papers backing up these claims of safety. So the majority of the science brigade stand on the side that says everything is going to be okay. And the critics are not even sure that they’re right. The problem for those of us outside of physics (and The Biologista is very much unsure what a Higgs boson actually is), is that the portents of doom, and the defences against these, are delivered in very difficult physics-speak.

Look up

So how do we satisfy our scepticism and sooth our, let’s face it, fear? There is on easily palatable piece of scientific knowledge that can put our minds at ease. The collisions that will take place in the LHC in these coming years have already happened countless trillions of times all around us, or more specifically, above us. As I already stated, the upper atmosphere is constantly bombarded with particles from space. These particles are of all shapes and sizes and impact at energies that are higher than anything the LHC can produce. Indeed, even stronger impacts than these occur around neutron stars and white dwarf stars. And these bodies have such a huge gravity that any possible micro black holes formed would surely not escape to space but would come to rest within the stars, gobbling them up from within in a spectacular and frightening manner. Given how often such collisions take place that ought to mean we’d see loads of white dwarfs and neutron stars popping their celestial clogs left right and centre. But we don’t. In fact, we never have.

It could also be said that at a certain point we have to have, I hesitate to use the word, faith in the physicists. I can feel fairly certain that the very clever employees at CERN, which hosts the LHC, would rather not die. And despite media portrayals to the contrary, scientific experimentation has a great safety record. The Mad Scientist bringing doom due to his meddling with nature is a myth based more upon the failings of the products of science in the hands of others than on the actual practice of research itself. Three Mile Island and Chernobyl were built upon scientific knowledge, but they exploded in ignorance of science.

Whilst we might doubt the motives of military research and commercial research such as the big pharmaceuticals companies and the nuclear industry, the LHC is something quite unique. You see, there’s no direct commercial or military benefit to it at all. On the contrary, the LHC represents the rarest of things in modern science; billions of euros spent in the pursuit of... knowledge. Nothing more. In June, Wagner’s case in the US was dismissed, and a similar case brought in the EU was dismissed just last week.

Trillions of natural test runs in our atmosphere, numerous independent safety reviews, two peer reviewed defence papers, the survival instinct of scientists and above all, a noble goal. Perhaps I’m naieve, but that’s good enough for me.

Alternative Expectations

Scepticism is a balancing act. It’s not about a dismissive nature, any more than a credulous one. I like to think of myself as being a balanced, quite open-minded sceptic. Doubt, but don’t reject without evidence. Mind you, I get it wrong sometimes. Watching a fairly mindless piece of entertainment TV last week, I was introduced to the concept of light therapy, in particular for the treatment of depression as well as skin conditions. I could barely contain a snort of mockery as the wide-eyed presenter explained the serotonin-inducing and antibiotic wonders of various shades of intense light. Actually, I’m pretty sure I didn’t contain it at all. My automatic mistrust of the concept was hasty. After all, it is quite well established that sunlight may have all manner of influences on us, both emotional and physical. However, my scepticism led me to investigate further, which is never a bad thing. I visited Google Scholar to browse some of the peer-reviewed journals on light therapy. My aim; to find out if any evidence of the effectiveness of this therapy actually exists. Sure enough, there is some manner of science in there. Broadly, the studies performed to date have tended to be pretty inadequate in terms of sample size (rarely more than 20 patients) and time scale (weeks when we’d like years). So let’s say that the jury is still out, but that I look more favourably on the concept now than I did previously. I’m still a little dubious as to whether such treatments should already be available in clinics, when it appears as if a full-scale trial has yet to be conducted. It wouldn’t happen with a drug, after all. The wide-eyed presenter, perhaps familiar with the concept of “scepticism”, ensured us that the treatment was “scientifically proven”. Whatever that means.

So I figure that light therapy should not be dismissed. But it should certainly not be accepted on the basis of a TV personality’s assessment of what constitutes “scientific proof”. While light therapy may not be something that would conventionally be classed as “alternative medicine”, it did get me thinking about the topic. The very concept of alternative medicine is often offensive to many medics and scientists. It is a notion that thrives on the modern public’s disillusionment with science in general and the misguided concept that “another way” exists. The disillusionment is not entirely unjustified. And the philosophical rejection of reason shouldn’t prejudice our scientific judgement of the individual therapies classed under the blanket term of “alternative”. Just where did this sense of disillusionment with conventional medicine come from? I have some notions on that. Following the sudden revolution that began with the sanitation practices of the late 19th century, the western world witnessed an unprecedented improvement in public health. The work of scientists such as Koch and Pasteur did away with vague notions of the nature of disease. Ever hear of miasma theory? Nope, because it’s rubbish. Koch and Pasteur, giants of medicine, saw to it that the war upon germs could begin in earnest. Within a century the world’s greatest killers, smallpox, tuberculosis and polio, were either utterly destroyed or reduced to a shadow of their former threat. It was a true revolution. It was the end result of a paradigm shift in biology; the formulation of germ theory. But things have settled down now, we’re back to normal science. Cancer, once largely unheard of, is now the big killer. Many blame modern life, and the science that brought it, for putting things into their food and environment. The newspapers are obsessed with reporting on “things that cause cancer”, which apparently is almost everything. It’s easy to forget of course that 100 years ago very few people lived long enough to get cancer. Modern medicine’s perceived inability to “cure” cancer, heart disease and AIDS, has lead people to lose faith, even to become cynical about the means and even motives of doctors and the health industry. Of course, we scientists and doctors have not helped. Our curious culture of maintaining aloof superiority has fuelled the common man’s sense that science has become disconnected from humanity. In the absence of understandable contact from us, what has anybody to go on other than the caricatures of the media?

So, the “other way” becomes attractive. Dismissive scepticism, the worst kind of scepticism, now rules when dealing with doctors. Many have come to the assumption that alternative medicine forms part of what They Don’t Want You to Know, for reasons that are never entirely clear. A grand conspiracy. This attitude is no better than the average scientist’s blanket views on alternative therapy. It’s really just a matter of getting more information, and if we actually look for it, the beginnings of what we need to know are often already there in the journals. What should the average prospective patient look out for? The journals don’t make for an easy read, but I’ll try to summarise what makes for good testing.

In evidence-based medicine, efficacy and safety are tested using clinical studies. Because humans are so very unique and variable, the only way to be sure that a technique or drug is effective and safe is to go large. To use the biggest study groups possible. We also have to ensure that we study the effects over extended time periods. Both features are vital for the statistical analysis needed to make sense of all that human unpredictability. Most importantly of all we must use what scientists call “controls”. A control in a clinical study is essentially a group, as large and as similar as possible to the group receiving the test treatment, which is treated differently for the sake of comparison. To properly test acupuncture, for example, the bare minimum would be a study of several thousand patients with one group receiving conventional treatment, one receiving acupuncture and one receiving “sham” acupuncture in which the needles are applied but applied incorrectly. The last two groups must be “blinded”, which is to say that neither group should be aware of which is receiving real acupuncture.

A recent-ish study of acupuncture for back-pain followed this very template. They found that acupuncture beat conventional therapy for pain relief. But that isn’t the full story. Firstly, the volunteers consisted of patients for whom conventional therapy had failed. Secondly, they found that the sham acupuncture was just as effective as real acupuncture. This may be an indication of what is called the placebo effect. This is an apparent beneficial effect caused by a fake control treatment, be it the administration of a sugar pill or random pinpricks. Or perhaps there’s some peculiar value to being poked with needles in general. Put simply, it’s not clear what’s going on there. Acupuncture must remain in the realms of the untested for now and we should treat it as such. With doubt, but not with contempt.

On the flip side, we can ditch reiki and reflexology as they have been tested quite thoroughly and found to have no greater benefit than a massage. “Allergy tests” based upon applied kinesiology (the one where bottles of varies substances are held near your muscles) are pure and utter witchcraft in my view. There’s no connection between the results of these and the standard medical allergy test. Hell, some of those tests use sealed bottles, so quite how your body could ever react to the contents is a mystery. As for chiropractic... don’t get me started. Few studies have been able to demonstrate anything more than a placebo effect. Most damningly of all, as pointed out by Ben Goldacre, some chiropractors would rather block the process of scientific criticism of their field. The New Zealand Chiropractors Association has taken the highly suspicious step of attempting to sue a peer-reviewed journal. With your health on the line, is this the sort of carry-on you should accept from your doctor? (Author's Note 21 Aug 2008: The British Chiropractic Association are also sueing journalist Simon Singh for an allegedly libellous article on their faith. I mean, science.)You can be quite sure that no reputable scientist has ever sued in response to academic criticism. Proper studies such as I outlined above are hard to conduct on chiropractic spinal manipulation. This is primarily because the medics who usually run studies are not trained in the methods and chiropractors are reluctant to get involved. What information there is tends to be both limited and self-contradictory. This isn’t a nail in the coffin by any means, but it’s clear that the professionals could be doing more to make us trust them. The general folk and herbal medicine scene is a whole can of worms in its own right. It’s quite clear that some of it works, after all many modern drugs are derived from plant and fungal components. But it’s clear that we don’t know enough about the complex mixture of active ingredients in many such preparations to draw generalisations. Much like light therapy and acupuncture, it remains for me at the fringes of reason for the time being. Ultimately, the advice for navigating the maze that is alternative medicine is much the same as my advice regarding the reading of science in the mainstream media. Scepticism, but open scepticism. Demand evidence, statistics and hard facts. Mechanisms must be rooted in what we can observe. As for doctors, expect more from them too. Ask for explanations, don’t just accept prescriptions. Doctors are often impatient with patient questioning and take a dim view of patients coming to them with their own research from books or the internet. This needs to change. Try to open a dialogue, one that is respectful and yet still sceptical. Never forget that your doctor has some ten years of training and perhaps decades of practical experience. The relationship should ideally be a two-way communication.

As for “alternative medicine”, the term encompasses too wide a range of ideas and carries too much prejudice. To my mind there should be only two kinds of medicine. Tested and not. Only the successfully tested has a place in our lives. Much of what is now untested may one day be worthy of our trust, but right now our health and our lives are at stake. Nothing is more valuable, and nothing is more worthy of healthy scepticism.

It's Revolution, Baby

Science is usually portrayed and imagined as one of two clichés. The scientific establishment is a vast panel of crusty old sceptics, dismissive of innovative thinking and ever willing to attack upstarts. On the flip side of this, “revolutionary” science is so frequently fanfared to the front pages of newspapers that we could almost believe that scientists are as excitable and credulous as the tabloids appear to be. Everyone loves a David and Goliath story, so it is hardly surprising that every controversial finding is pounced upon. Miracle cures and perpetual motion machines are all the more exciting when it appears that they show up those stuffy old boffins. Strange how the rebels and their miracles most often vanish without further updates. With so many contradictory findings being touted each week, it’s easy to see why so many people become disillusioned with science. Going by the newspapers, I’m still not sure if my coffee addiction is going to give me a stroke or save me from a heart attack. In my previous blog (Science Says) I talked about why I think this happens, and why it’s not actually a reflection on proper science at all. True scientific revolution is another story and an exciting one. Maybe not “tabloid exciting” though.

The best explanation as to How Breakthroughs Happen goes like this. A couple of years ago I was fortunate enough to work with a rare kind of scientist. The man, who we shall simply call Oz, is to my mind one of an elite subset of scientists who dedicate their careers to answering a single, if profound question. Oz is also something of a philosophy buff and introduced me to the scientific philosophies of Thomas Kuhn, a man who had a lot to say on the matter of scientific revolutions. On the small scale, science is a cyclical process, as I outlined in First Assumptions. Hypothesise, test, refine, repeat. In time, hypothesis becomes theory or a new part of an existing theory. We can call the prevailing set of theories the “standing model” as they represent a human modelling of reality as we see it. Conferences and the peer review process serves as a rigorous test of the output of the scientific cycle. Scientists are a competitive, aggressive bunch. Attack, until only the truth remains. This constitutes what Kuhn called “normal science”. An overall model, the standing theory is in place, and scientists are filling in the blanks. It is tough work and worthy work. But, as the normal science phase drags on, discrepancies begin to arise.

When Isaac Newton published his theory of universal gravitation in 1687, it represented a fundamental change in the scientific understanding of the universe. It was a true piece of revolutionary science that dismissed theories as old as Aristotle. Once it was put forward and accepted by the community, normal science proceeded. Newton’s theory remained the standing model for over 200 years as the universe was measured and scrutinized using newer and better technologies. The cracks began to show. The movements of some of the planets didn’t fit the theory. The effects of gravity on light didn’t seem to either. And there was more. As always happens, a few contradictory measurements will tend to be dismissed as errors. But as they mount up, efforts will be made to explain them away within the context of the current model. This may well resolve the situation, but for Newton’s legacy this did not suffice. The physics community had entered what Kuhn called a “crisis phase”. The standing theory was clearly inaccurate, yet no theory existed to replace it. New hypotheses were put forward, amongst them the notion that the universe was filled with some manner of “aether”.

In 1905, almost unnoticed, a patent office clerk called Albert Einstein suggested a few things that might help explain how light worked. He demonstrated his ideas via some nice publications which were pretty much entirely dismissed as being a bit strange. A few years later, with a PhD under his belt, Einstein went the whole hog and published General Relativity, a new model that explained pretty much everything that was inconsistent in the Newtonian model and blew the aether out the window. The new thinking was so fundamentally different to Newton’s view of the universe that there was considerable resistance to his new model. As with all new science, revolutionary or otherwise, it had to face the purifying fire of skepticism, particularly from the aether heads. It wasn’t until 1919 that the experimental confirmations finally started to emerge. Einstein’s hypothesis prevailed and within a few years the scientific crisis was resolved. Kuhn called this sort of changeover a “paradigm shift”. The information, the observations, they’re still the same. The understanding has changed. Although the more recent notions of the aether-filled universe was now dismissed, Newton’s theories were not abolished. Instead they became merely a small part of a much bigger picture. Used for simple calculations where Einstein’s equations would be overkill. And so, the task of filling in the blanks in the new model began. Normal science was resumed.

Whilst scientists are often painted as inflexible types sticking to their established knowledge and rejecting change, the reality is that this resistance to change is as valuable as the change itself. It ensures that only the most robust hypotheses become theory. We stuffy boffins are always aware that one day the theories that we hold to may be superseded just as Newton was or may be overturned completely. Almost 100 years later, General Relativity, with additions, is still the accepted model. Yet at the extreme ends of physics the cracks are showing once again. It is perhaps ironic that it was Einstein’s ideas regarding the nature of light that would lead to the birth of Quantum Theory, a model which may one day lead to the next great paradigm shift in physics. For those interested, read up on the Large Hadron Collider. This year it may just prove or disprove a huge chunk of Quantum Theory. I have only a vague idea how, mind you. Physics is witchcraft in my books.

Normal science, crisis, paradigm shift, repeat. It’s a pattern that gave birth to giants of science such as Theory of Evolution and the Galilean model, or such field-specific shifts as the discovery of adaptive immunity. Don’t worry, I’ll probably write about those ones some day. My point is that paradigm shifts may change an entire arm of science, such as Biology, or just a small corner of that arm. Dr. Oz is, to my mind, on his way to heralding a paradigm shift in Biology. He’s in one of those small corners of the field, but the implications of his work speak for themselves. He’s convinced me, at least. The information hasn’t changed, but the way I understand it will never be the same. Let the crisis begin.

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.