The Quackometer

Healing fools. The seemingly miraculous ability of our bodies to naturally fight and recover from illness, and our inquisitive brains that are eager to seek out causative patterns in all things, means that we all too readily attribute our healing moments to whatever magic beans we were rubbing at the time. Some are so impressed by their own healing stories that they start to make businesses selecting the appropriate beans for others' healing. And the rest of us listen to the tales of the healing fools, as a sincerely told story appears to hold such power over us. Without care, we all risk becoming healing fools.

Healing stories, or anecdotes, are the rocket fuel of alternative medicine. No matter how carefully the evidence against a treatment has been collected , or the shear implausibility of a mechanism has been explained, somehow the heartfelt and sincere story of a fellow suffering human trumps all reason. As humans, our evolved brains resonate with the stories of those we trust. But, if we care about our health, there are good reasons why we should distrust such healing testimony. Humans are fallible in many ways, and our willingness to see patterns where none exist, our readiness to please those that do us favours, and our desire to believe that what we wish to be true, leads to the stories of quackery taking a deep hold.

And when our illnesses are life threatening, we need good stories and effective actions to guide us back to health.

Let us look at two stories. The first is from Jeanette Winterson's defence of homeopathic AIDS clinics that appeared in the Guardian a couple of weeks ago,

Edwin Cameron, a justice of South Africa's supreme court of appeal who is HIV positive, has done much to counter the disastrous Aids denialists there. He visited Maun and agreed in writing that "there are patent health benefits". He also admitted that, although initially sceptical of homeopathy, he had had a persistent mouth and gum disease, untreatable by antibiotics, but which was cleared by homeopathic intervention.

As Winterson might say, 'dramatic stuff'.

More drama in the second story:

It was very dramatic. By the end of October 1997, I suddenly became very sick with a lung infection... I had lost an enormous amount of weight, my immune system had stopped functioning and the virus was raging throughout my body.

I knew that I had to contemplate this treatment... which was fantastically expensive... way out of the reach of most Africans with Aids or HIV.

Within 10 days of starting anti-retroviral medication, I knew that a physiological miracle was happening within me. I knew that the virus had come to a standstill. I felt my health, my energy, my appetite and my joy for life returning.

Now, I can tell you that one of these anecdotes is probably a misrepresention - the other is probably a very fair representation of reality. Which story do we trust? How can we tell these superficially equal plausible accounts apart?



The temptation is to look at the authority of the story teller. The first anecdote is told by 'top intellectual' Jeanette Winterson about the experience of a Supreme Court Justice; the second, by some anonymous African. But as even Winterson would tell us, we cannot and should not privilege the author in finding meaning. But where I might start to differ from Winterson is that we can privileged science. We can attribute authority to the process of collecting data, compiling evidence and testing against theory. The authority of science comes from its constant quest to falsify: ten thousand voices looking to criticise, to find holes and to knock down. When an explanation is left standing, then it can gain the authority required for us to place trust. And when wanting to heal desperately ill people, we need good authoritative evidence and theory, and to not be fooled by our 'authoritative' stories.

And fortunately for millions of people, there is authoritative evidence for how HIV infection can be managed so that they can lead normal lives without undue risk of death. This is not the place to go into that evidence - you can look into it yourself. The Cochrane HIV/AIDS Group compiles a list of of all the evidence for various therapies and treatments, both biomedical and behavioural/social. How very holistic. It goes without saying that homeopathy plays no role in the evidence base of how HIV/AIDS may be managed. Antiretrovirals have proven very effective and have saved countless lives.

It would look as if the teller of our second anecdote was much closer to the truth. But with all good stories, there is a twist and the unexpected. I was not entirely truthful about the second story coming from an 'anonymous African'. The speaker of those words was indeed also the Honourable Mr Justice Edwin Cameron of the South African Supreme Court of Appeal.

Justice Cameron is a startling character and one of the foremost Human Rights activists in the world. He was instrumental in ensuring South Africa had the first Constitution in the world to protect the rights of gay and lesbian people. He was appointed by Nelson Mandela to join special commission into illegal arms trading. Importantly, he has made huge progress in ensuring that South Africans have access to antiretroviral drugs and has been confronting the denialist stance of senior politicians in the region, eventually resulting in President Thabo Mbeke conceding and giving the go-ahead to distribute essential drugs to those that need them.

So, can both anecdotes be true? Can someone who has campaigned so vigorously for medical intervention for Africans with HIV really be a supporter of homeopathic quackery? Well, maybe a letter that Cameron sent to the Guardian (so far unpublished) will answer that,

Jeanette Winterson in her defence of homeopathy ('In defence of homeopathy', Guardian Tuesday 13 November 2007) ascribes words to me I never used. On a visit in June this year, I was impressed with the work of the Maun homeopaths, which is strictly supplemental to the Botswana government's provision of anti-retroviral treatments for AIDS. But I did not say there were patent benefits to homeopathy - nor could I have. I merely noted that patients reported experiencing such benefits.

A key point I have made in my challenge to the South African government's response to AIDS - including President Mbeki's lamentable dalliance with AIDS denialism - is that medical facts are best determined by science. I am not a doctor or a scientist. Winterson is therefore on the wrong tack to invoke - and quote incorrectly - my personal impressions in this field.

Edwin Cameron, Supreme Court of Appeal of South Africa

Dramatic stuff.

Now one thing I would disagree on is that Maun homeopaths can be 'strictly supplemental'. That is something they find very hard to be, as the whole philosophy of homeopathy is defined in opposition to real medicine and what they call 'allopathy'. Homeopathy is an alternative medicine and not a complementary medicine. As such, it risks people putting their trust in the wrong places. It is worth repeating the words of Yusef Azad, Director of Policy and Campaigns for the National AIDS Trust,

The tragedy is that there are still far too many governments not funding the treatment properly, and too many people with HIV who have not been informed of its benefits. Quack cures abound of course, all unproven, all cruelly deceiving, all a massive distraction from what we know genuinely works.

Also, the words of the Treatment Action Campaign, echo Cameron's trust of science,

We recommend that you DO NOT put your trust in one of the numerous people and organisations offering cures and treatments for HIV/AIDS. Many people with HIV are taken advantage of by unscrupulous charlatans or well-intentioned but uninformed people. Learn the science and trust the science. HIV is a manageable chronic disease if you follow sound medical advice. It is deadly if you do not.

So, Jeanette Winterson has been telling us stories again. In the words of Lord Melvin Bragg when interviewing her on the South Bank Show,

You say 'I'm telling stories - trust me' - why should we?

Labels: homeopathy

 

On the eve of the Society of Homeopaths' symposium in London on homeopathy and AIDS, the SoH issue a press release. It is a statement about how they are warm and cuddly and complementary and working oh so hard to dominate create a single register of homeopaths. They are definitely not promoting quack cures for AIDS.

It is well documented now about how so many of their press releases are simply misleading. (The current press release is thoroughly taken apart by Gimpy).

What caught my eye was the link at the end to the National AIDS Trust. Did this organisation support them, endorse their views and think homeopathy has a role in AIDS management? I had to find out. So, I emailed their policy advisor, Alana Lewis.

Yusef Azad, their Director of Policy and Campaigns, emailed me back to say that, of course, they do not support the seminar and would be in contact with SoH. He rang them. And now, the reference has been removed from the online press release. Their excuse was that it was a reference for their AIDS figures. Typical quack referencing: incomplete, inappropriate and confusing.

Tomorrow is World AIDS day. Yusef has this to say:

"There is no current cure for HIV. But there is effective treatment in the form of antiretroviral therapy which is saving millions of people and enabling them to live healthy active lives. The tragedy is that there are still far too many governments not funding the treatment properly, and too many people with HIV who have not been informed of its benefits. Quack cures abound of course, all unproven, all cruelly deceiving, all a massive distraction from what we know genuinely works."

I really cannot add anymore.

Labels: homeopathy, Society of Homeopaths

 

The Daily Mail have re-printed the Guardian's homeopathic spat between Jeanette Winterson and Ben Goldacre. Both articles (trimmed down) are now head-to-head.

But not all is at it seams. I have done some photo analysis on the pictures on that page and uncovered a disturbing truth. Look at the picture below. After some photo manipulation I have been able to reveal this...

Look at the picture close up. Who do you see? Now get out of your chair and look again from ten feet away.

Proof that this is a Big Pharma stitch up by getting novelist to defend homeopathy and make it look silly. Or was Goldacre behind the whole thing? Is Jeanette Winterson for real? Who can we trust? Is Jeanette Ben's nom-de-Friday-night after a hectic week at the hospital and delivery of his Bad Science copy?

Labels: Ben Goldacre, fun

 

Readers of Prospect Magazine have voted Jeanette Winterson as one of Britain's 'top intellectuals', falling well below Richard Dawkins and Germaine Greer, and somewhat below Matt Ridley, recently resigned chairman of the troubled Northern Rock bank.

There have been a number of articles in the press recently criticising homeopathic remedies as worthless at best, and potentially lethal at worst, if they are being taken instead of tried-and-tested conventional medicines for conditions such as malaria or HIV.

Of particular concern is a claim by the British homeopath Peter Chapel [sic] and his Dutch colleague, Harry Van Der Zee, that Chapel [sic] has developed a remedy, PC1, that can be used to treat the HIV virus.

it is hard to talk about what it is that homeopathy actually does,

where is the [...] sense in saying that because [homeopaths] don't understand something, even though [homeopaths] can discern its effects, [homeopaths] have to ignore it, scorn it, or suppress it?

The patients in Botswana have no knowledge about homeopathy, and are very rarely interested in learning more. All they need to know is that the homeopaths have helped a neighbour or a relative and, personal recommendation being the way of life in Africa, they come full of confidence that they’ll be healed.

For the people visiting the clinic, we are “doctors”. A bit weird for doctors - no white coats, no nurses, the clinic is sometimes a bit of shade and a couple of plastic chairs, and the pills are small and few - but they seem to trust us more than the doctors in the hospital, who never seem to have time to listen.

Labels: celebrity quackery, homeopathy, Society of Homeopaths

 

Last June, I wrote about emerging company, Exradia, and their attempts to sell a magic mobile phone battery to the major handset manufacturers, such as Nokia and Sony Ericsson. Their replacement batteries are supposed to offer health benefits to their owners by jiggling around with the electrical currents in the battery. (Don't ask me - it's their theory.)

What was shocking about Exradia was they were not your usual flaky snake-oil merchants or slick charlatans; these were well connected and well funded business people who were out to do a professional and smooth job. However, this is is what I wrote:

My guess is that Exradia executives will spend a futile Summer camped in Sweden and Finland and, when it starts getting cold, the push into retail sales will begin. Even then, flogging magic batteries to the public is going to be hard work.

It looks like my prediction has come true. Of course the phone manufacturers did not want to know; anyone with a modicum of knowledge about the mobile industry could have predicted that. And selling a product's dubious health benefits to the public has always been a much easier task. And so, a push into the consumer market has begun. The old CEO is out, a new one in with new money, sales staff and tactics.

Out goes, James Fintain Lawler as CEO, a man with experience at Xerox and so knowledge of doing big deals between businesses, and in comes David G. Schick from Citigroup. Now until recently hiccaughs, Citi were seen as one of the greatest retail brands in the world. It is one of the few American banks that can claim to be a truly global brand, and is the largest company in the world. David was Senior Vice President of Citigroup’s Global Consumer Group, responsible for consumer sales and distribution strategies - just what you want if you need to hit the retail market hard.

So the management team is all lined up for flogging this stuff big time to the public. But what the team still appears to lack is anyone who might understand the science of what they are offering. And that is not a surprise, because scientifically, the Exradia magic batteries are a flight of fancy.

Let us remind ourselves of the pseudo-scientific talk that Exradia use about their batteries,

Living matter is composed of electrically charged particles that are in constant motion thereby generating electromagnetic fields. These EMFs form part of the natural electromagnetic background and are characterised by random both in time and space. Biological cells do not respond to these natural fields.

By contrast, cell phones and other digital wireless devices emit man-made EMFs that are constant in space over the dimensional scale of groups of biologically relevant frequencies. These regular or 'structured' EMFs have been shown to be bio-effective. One example of such an EMF is the pulsating RF signal produced by a GSM mobile phone

Central to their claims is their statement that somehow 'structured' electrical fields can somehow damage cells. This is far from being scientifically accepted. In fact, it is widely regarded as nonsense. There is a lot of claptrap out there being talked about 'information' carrying radiowaves being dangerous, with a lot of 'test tube' type experiments that claim to show an effect. Behind these studies are groups who appear to relish the idea that mobile phones can be dangerous. Exradia have been sponsoring their own studies and claim then that their technology has 'been proven to eliminate biological effects in all instances in which it has been tested in laboratory research'. But to an outsider, the research leaves many unanswered questions and looks highly implausible.

Exradia talk about 'protection from the known risks of EMFs', but elsewhere are the first to admit that mobiles have not been proven dangerous to health. Then they say that they offer the 'only solution that has been scientifically proven to neutralise, at its source, the potentially harmful biological effects of radiation emitted from mobile phones'. But no studies have been done on humans. And there are lots of weasel words around like 'may' and 'potentially'. I would be fascinated to see what an ASA panel or Trading Standards officer would make of it all.

So what are the new Exradia up to? Well, first, they have struck a deal with Maplins, a large electronics and hobbyist retailer in the UK. This is unlikely to satisfy their ambitions. Maplins customers are electronics enthusiasts. Fear of technology does not occur amongst their technophile customer base - and that is what Exradia want - fear that mobile phones will harm you.

If you want to use fear then you need to use a Daily Mail technique and 'think of the children' - and that is where Exradia are going next. They are re-branding their batteries as 'Angels^TM' and starting a full scale viral advertising campaign - hitting the likes of MySpace and Facebook - and so reaching out to their audience with kid-friendly branding. A new web-site has been launched, http://www.welcomeangels.com/, that offers competitions, downloads and other gimmicks to get the kids excited. All so very 21st Century and Web 2.0. But at the heart of this campaign is a rather nasty piece of market creation. No young person is going to buy an unnecessary and expensive battery when they already have one. You need to convince them somehow that their existing battery could be doing them harm. Basic marketing. Create a fear, a gap, a need. Offer a solution.

The basic flaw in this plan though is obvious. Despite being rather kid focused, young people will not respond to this sort of marketing. They are immortal and a fear of death will not motivate them. Just look at the failure of scare tactics against tobacco or drugs and the impossibility of signing an 18 year old up for life insurance or a pension. To make fear work, you need to get the parents - you need to get to the grown up somewhere.

And so, Exradia are spreading the fear though adult channels too. The ever compliant Independent newspaper have allowed Exradia Chief Executive Mr Schick to write and advertorial scare story,

There is incontrovertible evidence that wireless use has a biological effect on cells, which could be the first link in a chain leading to health problems.

Incontrovertible it may be that blasting cells with microwaves has an effect on them. But a plausible mechanism for initiating health problems at levels experience by mobile users? That is why he uses the word could.

And Exradia have been issuing press releases to coincide with the launch of the iPhone to say that users risk 'melting their brain' because the iPhone battery is not replaceable with a magic Exradia battery and so 'Apple has chosen to ignore this potential health issue'.

Personally, I find all this rather distasteful. It is a blatant attempt to cash in on people's inherent distrust of the unknown and their susceptibility to overrate unfamiliar risks. Mobiles do kill. But it is due to the humdrum risk of mobile using distracted road users. Kids can get hurt by mobiles - but this is much more likely to be as a side effect of bullying or during theft of a handset.

The big question is - will Exradia succeed? Again a prediction. They will not last out 2008. Maybe they will sling out the sales director in six months and try another last gasp at marketing. Much money is being pumped in, but patience will not last forever. And this market is hard. People love their mobiles and change them regularly. Their priority for new accessories for their phones are not magic batteries, but media cards, covers and downloads. Exradia have a Sisyphean task of keeping up with the never ending supply of new handsets and batteries. Lots have to sold to justify the R&D, testing and manufacturing logistics demanded by such rapidly changing technology. No start up, no matter how well funded, can burn cash for long without seeing prospects of huge sales. That is not going to happen for Exradia.

And, good grief! A whole blog entry without mentioning homeopaths. What is becoming of me?

Labels: electromagnetic quackery

 

I have added new analytical debunking capability to the quackometer by employing the subtle subversive humour of the lolcats. For each of the current top 10 web sites that you have been testing with the quackometer, I am providing a link to a lolcats version of the web site.

For example, take this site (Lilias Curtin: body detoxification),

Labels: fun

 

Radio 4's You and Yours programme has been running a series on Chronic Fatigue Syndrome/ME. Today saw the last in the series and concentrated on 'alternative treatments' for patients who do not get 'satisfaction' from their GP.

ME is a quack's dream. It does not have a specific set of diagnostic criteria - it is what left when all other possibilities have been ruled out - follows a cyclical pattern of symptoms, and tends to get better on its own. Kerching. As such, the Radio 4 programme explored the full zoology of quack therapies for ME, including reflexology, nutritional therapy, mickel therapy and, of course, homeopathy.

The first homeopath to be interviewed was Dr Susie Rockwell, who is an NHS GP, but also runs her own private homeopathy clinic. She points out on her website the rather confusing contradiction,

I advise on management and treatment according to NICE guidance. This guidance does not support the use of complementary therapies in CFS/ME as there is currently insufficient evidence for their use. However a wide range of complementary therapies have been tried in CFS/ME and I can advise about which may be useful and how to access them.

Since completing and reporting on this study, I have reflected on and researched the relevance and appropriateness of the design of this study for investigating homeopathic treatment. (...) At the time of designing this trial, I believed the triple/double-blind placebo randomized controlled trial fit these criteria.

In retrospect, however, it is clear that the presence of a placebo arm in a study of homeopathic treatment can compromise the practice of homeopathy. In a further paper, colleagues and I conclude that “It is not reasonable to assume that the specific effects of homeopathic medicine and the non-specific effects of consultations are independent of each other—specific effects of the medicine (as manifested by patients’ reactions) may influence the nature of subsequent consultations and the non-specific effects of the consultation may enhance or diminish the effects of the medicine.” and that “For clinical trials of homeopathy to be accurate representations of practice, we need modified designs that take into account the complexity of the homeopathic intervention.”.

It is probably the case that the results of the CFS/ME homeopathic treatment trial were influenced by the existence of a placebo arm in the study. (...) They are also a possible explanation why only small effects are seen in placebo-controlled trials of homeopathy.

Whilst placebo-controlled trials of specific homeopathic remedies are valid, it is time to halt the misguided task of conducting placebo-controlled RCTs to test efficacy of individualized treatments; to redirect our energies to analyses of whole-systems health care and to design more relevant and meaningful pragmatic studies of comparative effectiveness, where untested treatments are compared to those where there is evidence of effectiveness.”

Labels: homeopathy

 

Put down your sweaty iPod Touch and slide your fingers over the downy back of the Quackometer as it makes its debut in the funky new world of podcasting.

Yes, I am the guest this week on the Guardian Science Weekly Podcast, and we discuss the language of quackery. My warm-up and support act is some Canadian academic chappie by the name of Steven Pinker. He sounds quite clever but swears a lot. If he can clean up his potty mouth then he might go far.

So, we discuss the birth of the Quackometer and why quacks feel the need to appropriate the language of science (and especially physics), the merits of organic food, and the magic watergate scandal. There is some minstrel at the end who sings about evolution, talk of elephants on acid, foul-mouthed mammals, and a serious bit about abortion. All good clean fun - well, it would be, if it wasn't for that Pinker bloke who, I think, rather lowered the tone. I doubt they will invite him back. Don't let your grannie get hold of your iPod and hear him. She will definatelty drop a stitch.

So, being a shy duck, I haven't listened to it yet. I hope they have cut out the bit where I ask, "So, how often does Science Weekly go out then?" If I have done OK, then they may be inviting me back for some more quackery podcast fun.

To listen,

Labels: podcasts

 

Labels: homeopathy, Society of Homeopaths