The Quackometer

The BMJ has today published an exchange between the British Chiropractic Association and Professor Edzard Ernst examining the claims of the BCA that chiropractic is effective in treating childhood ailments such as asthma and colic. The editorial of the BMJ has come down firmly supporting the assessment of Ernst. The editorial says,

His demolition of the 18 references is, to my mind, complete.

This would look like it is now the definitive assessment of these claims and buries any suggestion that the BCA can defend its claims on the strength of evidence.

Meanwhile, the BCA continues to pursue science writer Simon Singh through the courts for an alleged libel when Singh wrote in the Guardian that these treatments were ‘bogus’ and that the BCA were ‘happily promoting’ them. Despite the BMJ clearly showing that there is little evidence to support the BCA claims, they could still win against Singh as the trial judge, Eady, has ruled that the meaning of ‘bogus’ suggests that the BCA were being ‘deliberately dishonest’ in promoting these claims. Singh has since contended that what he meant was that the BCA were simply wrong in their assessment of evidence.

So, Richard Brown of the BCA kicks off by defending the chiropractors position. He starts by saying,

It is quite remarkable that scientists should expect themselves to become exempted from the laws of the land for publishing defamatory comments, be they about an individual or an organisation.

Brown shows his total misunderstanding of the situation in his first statement. It is not that scientists want to be seen as exceptions to the libel laws; rather, that science is hindered by the presence of English libel laws and their application in disputes of evidence is completely inappropriate.

The insidious thing about English libel law is that all you need to do to bring an action is to suggest that you have been defamed; that in some way your reputation has been lowered. But in science, by criticising ideas, it is inevitable that some degree of defamation will occur – that by showing someone's ideas are unsubstantiated and unsupportable their reputation may well be diminished in the eyes of their peers. The rules of the game in science are that this ‘defamation’ takes place in the open – most often in journals and conferences and public debate – not in the courtroom. Science is a tough calling. It is full of knock-about and direct challenge. In scientific medicine, the ethical demand is that public health is more important than any particular reputation. The BCA’s reputation is completely disposable if it means that people get better medical advice and treatments.

Brown then goes on – “there is in fact substantial evidence for the BCA to have made claims that chiropractors can help various childhood conditions.” This claim is then totally demolished in the following BMJ article that looks at Brown’s references and pulls the weak evidence apart and shows it to be completely lacking. Damningly, the review shows that the BCA have cherry picked their evidence and ignored high quality trials that suggest chiropractic is not effective for treating the named conditions.

And then in a bombshell, Ernst suggests that.

The omissions are all the more curious as the Association apparently knew of these [ignored] articles.

And then goes on to explain why. This would suggest that the BCA were deliberately ignoring pertinent negative evidence in their justification of their stance. Ernst concluded that,

The association’s evidence is neither complete nor, in my view, “substantial.”

This allegation would suggest that even if Singh were unable to overturn Eady’s decision that he must defend his article on the basis that the BCA were deliberately misleading in their statement, that it might be possible to prove that this is indeed the case.

So, what should the BCA do next? A few months ago, they must have been feeling rather pleased with themselves that the trial was going their way and I am sure they would have thought that Simon Singh would have folded his cards. That is not so true now. Indeed, Simon is fighting on and looks like he is prepared to go all the way. It is now clear that the BCA cannot defend their position on the basis of scientific evidence. They must now hope that it cannot be proven that they have deliberately deceived. However, cracks are now appearing even in this defence. Even if they were to win, the only conclusion that someone like myself can come to is that they may not have been deceiving, but that they are incompetent in their assessment of evidence. There does not look like a way the BCA can now ‘win’ in any moral sense.

And what this means is that the chiropractic profession is taking a battering like it has never seen before.

What is ironic is that if the BCA had written this article a year ago, as the Guardian had offered them the space to do so, all this would have been now forgotten. Chiropractic would have continued to thrive under their cloak of intellectual obscurity. But to pursue Simon through legal means only was their own decision, despite their claim that “The British Chiropractic Association (BCA) neither wished nor intended this matter to end up in the courtroom.” That is clearly not the case as they had alternatives presented to them and, indeed, they have belatedly taken up the alternatives in the pages of the BMJ.

And so, after some thought, several weeks ago, I have made a complaint to the GCC about the officers of the BCA for presenting misleading information to the public about the effectiveness of chiropractic in children. If they had written this article a year ago, I would not have done so. But if they feel happy that they do not have to defend their evidence in court now, perhaps they might be less happy that they now have to defend their position to their professional regulator. Their code of conduct is quite clear:

If chiropractors, or others on their behalf, do publicise, the information used must be factual and verifiable. The information must not be misleading or inaccurate in any way. It must not, in any way, abuse the trust of members of the public nor exploit
their lack of experience or knowledge about either health or chiropractic matters.

If you want to be treated like a regulated profession, then expect to be held against high standards.

Labels: British Chiropractic Association, chiropractors, edzard ernst, Simon Singh

 

The stillborn homeopathy campaign, Homeopathy Worked for Me, that attempted to collect 250,000 signatures but managed just a few percent of that, has now resorted to producing a laughably daft critique of Ernst & Singh’s Trick or Treatment.

William Alderson, a homeopath, has produced a 142 page response to the book that attempts to show that the book has “has no validity as a scientific examination of alternative medicine”. Entitled, Halloween Science, the critique is a collection of misunderstandings, quibbles, strawmen and just plain daftness.

The approach that Alderson is taking here is to produce so many half baked critiques that to debunk the whole work would take 500 pages or more. Even if I was to show that the first few pages contained nothing but nonsense, the charge could be made that the rest of the book must contain some well targeted criticism. The whole book is destined to become an exemplar of the Dunning-Kruger effect.

Nonetheless, given that I have a life, I have no choice but to pick out a few examples and display their total inadequacy to you. The rest I shall leave as an exercise to the reader. No doubt, as with any work, there may well be weaknesses in Trick or Treatment and Alderson may well stumble over a few of them. Whether this undermines the main argument of the book though is a different matter. In that regard, Alderson fails to plant any fatal punches.

For the easily bored, or for those with delicate foreheads (for you will be sure to be banging yours on the desk if you attempt to read the full tome), Alderson gracefully produces a précis of his magnum opus.

So, a quick example: early on in Trick or Treatment, Ernst and Singh show how early versions of clinical trials established effective treatments for sailors’ scurvy. By trialling different proposed remedies and comparing outcomes, the British Navy was able to eradicate the curse of scurvy by allowing sailors access to lemons and oranges, a good source of vitamin C.

Alderson contends that in doing so the authors are “confusing two types of intervention”.

In fact, we need to be clear that the condition which lemons, oranges or vitamin C are actually curing is the absence of vitamin C in the diet. In other words the treatment in this case is actually the ending of a harmful intervention (deprivation of vitamin C), and this harmful intervention is the one and only cause of the illness. In this respect dietary deficiency diseases and poisonings are totally different from infections or chronic diseases, where there are multiple causes. The point can be illustrated by reference to another of Ernst and Singh’s examples: loss of blood as a result of bloodletting simply requires one to stop depriving the patient of blood, whereas a haemorrhage requires an active intervention to be initiated to solve the problem. Nobody would call the former action a ‘cure’, yet that is precisely what Ernst and Singh are doing in the case of scurvy.

You might want to read that again, because, yes Alderson is really saying what you thought he did.

Before I highlight his error here, it is worth noting Alderson’s misplaced obsession with theory in medical treatments. He claims that Ernst and Singh ignore theory when they say that “by experimenting and observing, [we] can determine whether or not a particular therapy is effective.” Alderson contends that “Ernst and Singh [believe] the scientific method is about “experimenting and observing”, not about experimenting, observing and theory.” The observant might notice the Alderson is attacking an argument that the authors do not make. Ernst and Singh do not attempt to define science as being about “experimenting and observing” but that we can determine what facts are true about the world by such processes. We can understand if an intervention has an effect on a disease without having a theoretical understanding of the diseases nature. That may well come later.

Alderson obsesses about theory because, like a lot of homeopaths, he delights that homeopathy provides a theory of disease – imbalances in vital forces (or something) and a theory of cure – ‘like cures like’. Like all homeopaths, he does not understand that you cannot have a theory until you have a set of observations that need explaining by a theory. No such observations exist for homeopathy. In two hundred years, homeopaths have failed to produce a similar demonstration of efficacy as this primitive trial with lemons.

So, back to our scurvy problem. What Alderson is missing is that when citrus fruits were proposed as a cure for scurvy, that this was not based on any theory of disease. Indeed, it was completely unknown what caused the terrible disease amongst sailors. It could have been an infection or diet; some though the disease was caused by sailor’s laziness and so made sick sailors work harder. Physicians at the time had no knowledge of vitamins and the book makes this clear. The sailors’ trials tried different suggested remedies including cider, sulphuric acid, vinegar, sea water, garlic paste and, of course, oranges and lemons on twelve afflicted patients. The two given fruit recovered very quickly, the cider drinkers somewhat and the rest made no progress. As trials go, it is pretty primitive, but understandably compelling.

Even with this result, it would take a long time to establish that that the reason lemons worked was because of a dietary deficiency. Alderson is quite wrong to suggest that somehow the trial only worked because of the nature of the cause. In fact, the nature of the trial makes no assumptions about the cause of the illness; it merely seeks to determine what intervention has an effect on the illness. The trial has about as much need of theory as a ruler does of General Relativity. Alderson fails to state why this so called failure or ‘confusion’ had any bearing on this or any other trial.

The rest of Halloween Science is riddled with the same error and similar misunderstandings. What is unforgivable is that that Ernst and Singh go to some six pages explaining very carefully the same point I have made above. William Alderson does not, or chooses not to, understand.

Of course, the whole Alderson book is a mere fig-leaf. Its clumsy rhetoric and lengthy nitpicking is a disguise of the embarrassment that homeopaths have over the fact that they cannot produce any reliable evidence for the efficacy of their treatments and the validity of their hypotheses (not theories). This pamphlet may well please the homeopaths who continue to avoid acknowledging the genuine and urgent criticisms of their shabby trade (such as their refusal to condemn the practices of their colleagues who dish out sugar pills in Africa in order to 'prevent’ malaria or treat HIV infection). More competent readers will not be impressed.

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UPDATE

It is probably worth mentioning the section in Halloween Science that discusses the attempts by the Society Homeopaths to sue my internet service provider when I dared to criticise them.

William Alderson, a member of that society continues to misrepresent what happened in the most shocking way.

Ernst and Singh said in their book,

Worse still, when the Society of Homeopaths, based in Britain, was criticized for not taking a firm stand against inappropriate use of homeopathy, it decided to suppress criticism rather than to address the central issue. Andy Lewis, who runs a sceptical and satirical website (www.quackometer.net), had written about the Society and the issue of homeopathic malaria treatments, which resulted in the Society asking the company that hosts his website to remove the offending page. In our opinion, the Society needs to improve in three ways. First, it ought to police its practitioners more thoroughly. Second, it ought to act publicly and promptly when serious complaints are made. Third, it should listen to its critics rather than silence them.

You can read my criticism here. It is harsh – but the issue was very important.

At its most basic level, the Society fail to uphold their own code of conduct, never censor anyone for clear breaches and allow their members to offer dangerously misleading advice to the public. (Example here)Those charges demand a serious response. The Society have never done so.

Alderson responds to this rather serious charge by just quoting the Society asserting what good eggs they are. He then repeats the lie that the Society could not take action against any members as no information had been given to them. This is simple untrue as you can read here. To say that the society had nothing to “police” is an utter distortion. The Society is riddled with members who either support or who actively engage in immoral and dangerous uses of homeopathy on Africans with malaria or AIDS.

Alderson then claims that the Society was justified in calling in their lawyers because my remarks were not criticism but defamatory. I wrote to Paula Ross asking for an explanation. None was ever forthcoming. They simply wanted to silence me.

And the Society and their members made no meaningful attempt to stamp out dangerous practices. Indeed, they went on to host a conference on treating AIDS with sugar pills and have been financially supporting members experimenting on Africans with AIDS. Let me now defame them: despicable scum.

Labels: edzard ernst, homeopathy, Simon Singh

 

Labels: Ben Goldacre, chiropractors, edzard ernst, evidence based medicine, Gillian McKeith, quacks

 

Labels: edzard ernst, homeopathy

 

Edzard Ernst has accused practitioners of alternative medicine of lying to their patients. In last week's New Scientist he gave an interview where he described his childhood experiences with homeopathy, and his subsequent medical and homeopathic training, and his work in the only German homeopathic hospital. His conversion to doubt has been slow and guided by the evidence. He now believes that homeopathy is nothing more than a placebo therapy. That is what the science says. According to Ernst, the continued popularity of homeopathy is essentially due to homeopaths lying to their patients about the state of research into the subject. If they told the truth, their businesses may collapse.

Now, Dr Brian Kaplan, a medically qualified homeopath, has taken exception to Ernst remarks and thrown down the gauntlet - pistols at dawn. Kaplan says,

I have met hundreds if not thousands of homeopaths in my career. Some have indeed believed in some strange things, some have been very naive indeed in my opinion, but I have never met a homeopath whom I thought was lying to his/her patients. They may have said things to patients that Ernst thinks is untrue but that is very different from lying which is the deliberately not telling the truth.

Now, for once, I would pretty much like to agree with Kaplan. I think few homeopaths are out-and-out liars. Lying is not the word for what homeopaths do. The actual word that is most commonly appropriate is 'bullshitters'.

To explore this issue, I would like to draw on the work of renowned moral philosopher and Professor Emeritus of Philosophy at Princeton University, Harry G. Frankfurt. In 2005, Frankfurt published an essay entitled On Bullshit. This groundbreaking work explores the philosophical meanings of bullshit, why there is so much around and how it differs from other sorts of untruths.

Frankfurt argues that bullshitting is not the same thing as lying, but both are an abuse of the truth. In his words,

It is impossible for someone to lie unless he thinks he knows the truth. Producing bullshit requires no such conviction. A person who lies is thereby responding to the truth, and he is to that extent respectful of it. When an honest man speaks, he says only what he believes to be true; and for the liar, it is correspondingly indispensable that he considers his statements to be false. For the bullshitter, however, all these bets are off: he is neither on the side of the true nor on the side of the false. His eye is not on the facts at all, as the eyes of the honest man and of the liar are, except insofar as they may be pertinent to his interest in getting away with what he says. He does not care whether the things he says describe reality correctly. He just picks them out, or makes them up, to suit his purpose.

Homeopaths are renowned bullshitters. They do not care about the truth. They are extremely reluctant to say anything definitive that can be proven wrong. They do not test their ideas themselves in any meaningful way. They will say anything to make themselves look plausible in the face of sincere criticism. Instead of addressing the concerns raised by Ernst, they bullshit about conspiracy theories about how pharmaceutical companies are funding people like him to discredit them. There is not a shred of evidence for this - but that does not matter - they just bullshit away.

We saw Neal's Yard Remedies this week after they were caught dishing out useless sugar pills to prevent malaria bullshitting for England. Their PR department will undoubtedly be winning PR bullshit awards over that attempt to get-out of-gaol-free.

We have seen The Society of Homeopaths trying to bullshit their way out of similar accusations, issuing press releases that really did not appear to care if what they were saying was the truth. They claim to be consulting with the Department of Health over self-regulation. A freedom of information act request suggest otherwise.

We see their 'intellectuals' publishing papers on quantum mechanical explanations for homeopathy. It is utter bullshit of the highest order, but that does not matter, because the homeopaths lap it up.

When homeopaths, like Kaplan, only partially review the evidence for homeopathy, cherry picking the positive studies and ignoring the overwhelmingly disappointing, they are bullshitting. By continuously saying that meta-analyses are 'discredited' when they are not is just pure bullshit.

Bullshit may not cover all homeopaths abuses of the truth though. Some have seen Frankfurt's analysis of truth abuses as incomplete and in need of further revision and extension. It was therefore necessary for former Oxford Wilde Reader in Mental Philosophy and current Professor of Philosophy at the University of Miami to publish an essay entitled mindfucking.

McGinn's 2008 analysis notes that not everyone who engages in speaking without regard to the truth is a bullshitter. They may well be just telling stories, or singing a song, and is not making any claims to be either telling the truth or a lie. Defining a bullshitter cannot be done by just noticing a disregard for truth.

In examining the true nature of bullshit, we discover that in order to be a bullshitter you must intentionally represent yourself as competent and sincere and be trying to place this false belief in the listeners head that you are telling the truth. As such, a bullshitter is not completely indifferent to truth and falsehood as Frankfurt has suggested. We can see how homeopaths publishing papers on quantum mechanics gives the impression that they know what they are talking about in this area. There is the intention to come across as an authority. The fact that these papers are not published in quantum physics journals should set off loud alarm bells. There is no one in an alternative medicine journal capable of telling the authors that the paper is bullshit and so rejecting it.

But deeper into this new analysis of truth abuse comes the concept of mindfucking. Both liars and bullshitters are concerned with beliefs - that of what their listeners think. There are always two untruths for the liar and the bullshitter - the (possible) untruth of what is being said and the untruth of the belief in the listeners head that what is being said is sincere. The mindfucker, on the other hand, does not just care about their listeners beliefs and what the listener thinks of them, but about manipulating their emotions too. The intention is to disturb and abuse. The mindfucker seeks to raise emotions of alarm, confusion, insecurity, fear and hatred. At the very least, mindfucking is using emotion to manipulate thought.

And this is where we can see that homeopaths are most definitely mindfuckers. It is just not good enough to lie to you patients about the power of the pills. It is also not good enough to bullshit about evidence. Homeopaths find it necessary to fuck with people's minds. They tell them that the real enemy is their doctor. They scare them in one-sided stories about the harm that drugs and immunisations do. They tell them their medication will do them more harm than good. They talk incessantly about side-effects of drugs as if the actual effects of the drugs and the illness itself were secondary issues.

Is Kaplan guilty of a mindfuck in his criticism of Ernst? Instead of addressing Ernst's evidence of the ineffectiveness of the majority of complementary medicine, Kaplan accuses Ernst of ignoring the supposed lack of evidence behind conventional medicine. It is a mindfuck because it plays to the usual emotion of distrust in Big Pharma, it deflects from the issue and seeks to cause alarm about Ernst's motives. But of course, Ernst is Britain's only Professor of Complementary Medicine and it is a complete red herring to accuse him of ignoring a subject that he never intended to study. There are thousands of researchers in Britain studying and improving the evidence base of medicine and yet Kaplan wants to attack Ernst over it. The irony is of course is that Ernst is improving the evidence base of CAM - people like Kaplan do not like the answers coming out of his department. Let's fuck with people's minds instead.

So, I am not sure if Ernst is going to take up Kaplan's offer of a duel. My bets would be on the canny German. They still train people to duel there, you know. Kaplan has not made a case that a duel is necessary. Rather, it is up to Kaplan to state that homeopaths do not misrepresent the truth about the evidence base for homeopathy. If he is sincere about the truth, why is he not as concerned about his own profession as Ernst appears to be? Where is the condemnation of homeopaths running high street shops with dangerous beliefs about immunisations? Where is the concern that homeopaths do not practice within the knowledge of a sound evidence base?

I think Ernst was actually being rather kind in calling homeopaths liars. He should have called them all bullshitters and mindfuckers.

Labels: edzard ernst, homeopathy