The Quackometer

I have just returned from Europe's first conference on science blogging. Held at the Royal Institution in London and organised by Nature Network, the conference was attended by science bloggers from all over the world.

The conference kicked off with a keynote speech from 'Britain's leading science blogger', Ben Goldacre, who talked about the superiority of bloggers to be first to important science stories, to report them more accurately and cover them in far more detail than any paper ever could. Bloggers in the UK had spotted the imminent financial collapse of the dyslexia 'miracle cure', Dore, whilst the TV and papers were still singing its praises. Blogs questioned the science behind the claims of Dore, whilst the traditional media swallowed it whole. Blogs have another advantage over paper media in the way that their authority is transparent and can easily be evaluated. Newspapers never reference or link to their sources - we have to take what they say at face value. Good blogs, in contrast, can and do link to primary scientific sources. We can check they are being honest in their appraisal of the evidence. We can ignore blogs that are shown to be dishonest in what they do. Comments sections invite a form of critical peer-review. Honesty and transparency are rewarded. The daft and dishonest blogs are quickly and mercilessly punished.

The day was followed by more sessions of the role of science blogs in engaging the public with science, the reasons why science bloggers blog and the use of technologies such as twitter and Second Life.

What struck me quite strongly is how unsophisticated the use of blogs within science is right now and that is what I want to explore. Science blogging was largely portrayed at the conference as single act with a common purpose - almost exclusively an act of self-expression with the intention of 'doing good' in educating the public. This is a rather one dimensional use of the technology and is far behind how other blogging groups use the technology - particularly business.

There may be number of good reasons for the shyness and shallowness of current science blogging. A surprising number of individuals described how they blogged anonymously. The principle reason for this was to ensure their academic superiors did not find out about their activities. Blogging is not perceived to be done by 'real scientists'. You should be at the lab bench or writing papers. Blogging is not seen to fulfil a valuable role in science. Many saw blogging as a threat to their careers - a few saw this a way of enhancing it.

And yet, the bloggers here obviously feel that their writing does fulfil a role. One University stood out in its progressive attitude to blogging. The University of Sydney paid for one of its bloggers to attend the conference in London. This fact drew gasps of amazement from the audience when it was revealed. The University actively encourages blogging. Blogs dot USYD is their showcase for their staff blogs and blogs are encouraged to help support research and projects. Even so, the initiative appears to have a much bigger take up amongst humanities faculty members than scientists.

I made the remark, during the closing session, that science appears to be lagging behind in its thinking about blogging. In contrast, many areas of commerce and industry are exploring and embracing blogging as a tool to aid communication, collaboration and innovation in ways that were not obvious at this conference . The businesses that are embracing blogs are explored in Tapscott and Williams Wikinomics: How Mass Collaboration Changes Everything (Amazon). Wikis and blogs are becoming common business tools to aid the creation of new ideas and value both within companies and across company boundaries into networks of suppliers and partners.

Recently, I attended a three day conference held by one of the world's largest banks about the latest ideas in risk management. The conference was dominated by talks on how blogs and wikis can create collaborating communities. People who work in banking risk are traditionally seen as being very conservative. The fact that large banks, working with blue chip partners, such as Sun, IBM and Cisco, can solve the issues associated with such new thinking should be a wake up call to science communities.

What these developments recognise is that the best ideas and solutions to problems are the valuable thing and it is a lesser concern where these ideas come from. Companies used to see themselves as being closed environments with good internal people coming up with new 'Intellectual Property' that the company can then exploit to make a profit. Rather than being the owners of the creative people, this new collaborative model sees companies being facilitators of the creative process. In the past, the companies that created and owned the most valuable patents would be the winners. Now, some companies are seeing the winners as being those that can best facilitate and manage the best networks of collaborators and Web 2.0 technologies are a great way to achieve that.

Of course, IP is a big issue. Collaborating companies have to have contracts to understand how they will share ownership of new ideas emerging from their mutual network of blogs and wikis. Scientific research too will have similar issues. Where research is commercially funded, there will be concerns about how ideas coming from that funding are disclosed and shared.

These are not insolvable problems. The first realisation is that blogs need not be public. Blogs can be contained within communities with appropriate access control. On the wall of the new Royal Institution canteen is a quote from Earl Wilson which says,

Science may never come up with a better office communication medium than the coffee break.

That may well be so, but today's research collaborators or office workers need not be two minutes from a shared coffee pot. Often continents divide them. Closed community blogs allow the 'thinking out loud' and the discussion of ideas that might normally take place over a dripping filter, without the risks and embarrassments of those thoughts being too free. It is possible to see a continuum of types of access to blogs, from fully public, to small intimate teams. Blogs can become one more tool for the testing and sharing of ideas, like a poster at a conference, rather than the full exposure of a paper in a journal.

This is the trick to using blogs. Much talk at the conference was about issues such as how citable blogs can be and even how they might challenge traditional peer-reviewed publishing. Henry Gee, a Senior Editor of Nature, put forward the argument that the defining feature of blogs was that they were provisional. They were there to be changed and updated and grow. Their provisionality fits well with the nature of science thinking. They can test ideas, often deliberately half-baked ideas - the best grow and flourish, the poor ones slide into history.

Blogs may not be necessarily the best medium for public science communication; they may not ever replace traditional peer-review. But they can become an excellent space for the exploration of ideas, both publicly and within closed communities. Lab work will not just be about notebooks and coffee breaks, but 'thinking out loud' on your blog and mercilessly critiquing your colleagues daft ideas.

Maybe there are science communities out there that already do this. Places like CERN must do: they invented the web just so they could share documents and create collaborating communities. Perhaps, Science Blogging 2008 was a self-selected audience of people from blogging communities such as ScienceBlogs, Nature Network, and BadScienceBlogs that blogged in a particular way. However, I saw little evidence at the event of more diverse ways of blogging than just 'for the Good'.

There was evidence of diversity of blogging within science, but this was more along the lines of differences between US and UK bloggers, or between scientists reporting their field and others attacking the abuses of science within society. I hope to be able to make it to the next blogging conference next year. Will there be more diverse uses of blogs? Will Universities be more encouraging of blogging activities amongst academics? Will networks of science communities be using blogs to collaborate in more interesting ways?



Technorati Tags: sciblog

Labels: sciblog

 

The decision by the British Chiropractic Association to sue Simon Singh will undoubtedly bring increased scrutiny of chiropractic. I would like to start with a first look at the education of chiropractors in the UK. This is also timely as Universities have recently been criticised for teaching quackery, resulting in a homeopathy degree being dropped by the University of Central Lancashire.

Chiropractic is going to be quite different from homeopathy though. Anyone can call themselves a homeopath. Having a diploma behind you helps in joining the various homeopathic pretend regulatory bodies. Have a BSc and you will be vastly overqualified by far to dish out sugar pills. Chiropractors, however, need to be registered with the General Chiropractic Council. Chiropractic is capable of causing injury to patients, sometimes even death. To be registered, you need to have studied chiropractic for at least four years to degree level including one year of clinical supervision. That is the law.

Labels: chiropractors

 

Hot on the heals of New Zealand Chiropractors trying to silence David Colquhoun and the The New Zealand Medical Journal, we learn today in the Telegraph that the British Chiropractic Association has issued a writ against Simon Singh for an article he wrote in the Guardian entitled Beware the Spinal Trap. 'Dr' Antoni Jakubowski of the BCA said that this was not a decision they were taking lightly. If justice is forthcoming, it will be a decision they regret.

The original article is no loner available on the Guardian site, but here are some excerpts that so offended the chiropractors.

Labels: British Chiropractic Association, chiropractors, Simon Singh

 

Chiropractors have an air of respectability about them. They style themselves, 'Doctor'. They wear white coats and have brass plaques outside their offices with lots of letters after their name. My friends look at be puzzled when I say they are quacks. But that is what the evidence says. Their practice is founded on strange ideas about mysterious things called 'subluxions' and pseudoscientific beliefs in 'inate intelligence' running through our nerves and bones. We think of chiropractors as being for bad backs, but their founding beliefs state that cracking bones can be a panacea. You will still find chiropractors claiming treatments for all sorts of weird and wonderful things.

The evidence for the effectiveness of chiropractic is not good. What evidence does exist suggests it is just another placebo treatment. It might work for lower back pain - but probably no more than a couple of paracetamol. And the risks of bone cracking can be quite severe with deaths reported by stroke. More minor adverse reactions appear to be quite common.

In the UK, chiropractors can thank their regulated status for much of their standing and freedom from ridicule that other quackery attracts - like homeopathy. Chiropractors are statutorily regulated. You need to be registered to call yourself one. You can even call yourself Doctor as long as you do not imply that you are medically trained - but that is hard. Brass plaques. White coats. X-ray machines. My best guess is that most people think of chiropractic as a branch of medicine. It is not. It is quackery and a business.

Some times though we see them for their true colours. The New Zealand Medical Journal has just been threatened by a law suite for publishing research into how chiropractors (mis)represent themselves to the public by using the title 'Dr'. Professor David Colquhoun wrote an editorial that put chiropractic deception into a wider context of their education and business practices. The response of the New Zealand Chiropractic Association was to get their lawyer to threaten to sue. The Medical Association has responded admirably by calling their bluff and asking for their evidence that what was being said is not true. "Let’s hear your evidence not your legal muscle."

That is how it should be. As Ben Goldacre has responded, the real medical world is full of self-criticism - often very harsh. The way to respond is with science and argument - not with lawyers. Legal threats are a business technique, not the actions of medical practitioners. They expose their true self by calling their lawyers.

As Professor Colquhoun notes, since the invention of chiropractic, their business acumen has been sharper than their scientific and medical expertise. Consultancies on how to grow your bone crunching businesses are rife in the US. As Rose Shapiro notes, its all about building "high-volume, subluxation-based, cash-driven, lifetime family wellness practices."

In the UK, we have similar chiropractors-turned-business gurus too. 'Dr' Terry Chimes, ex drummer with the Clash, is perhaps the highest profile. This year he has launched his 'Chiropractic Heaven' consultancy. Chimes promises to tell you the 'The Secrets of the World's Most Successful Chiropractors'. He does this over 120 weekly modules - all brimming with 'golden nuggets of wisdom '. And he claims to be able to 'Quadruple Your Practice in a Matter of Months. . . Ethically'.

Not all chiropractic business skills could claim to be ethical. Occasionally, the General Chiropractic Council of the UK is embarrassed enough to step in. In one case, a chiropractor was found to have "abused the trust of his patients, and coercing them, through alarmist scare tactics, into excessively protracted and unjustified treatment plans". Chiropractic lends itself to such approaches: it deals with long term chronic conditions, such as back ache, uses mysterious and unverifiable X-ray diagnostic techniques to alarm customers, and recommends long courses of treatments. The chiropractor in question was accused of using unjustified courses of X-rays and misrepresented the gravity of the customer's condition. The chiropractor was removed from the chiropractic register, but simply re-invented himself as a 'osteomyologist' - a sort of renegade and unregulated chiropractor in all but name.

It is amazing that all chiropractors cannot be charged with using unjustified X-rays. Since, their bone crunching cannot be showed to be medically effective, X-rays cannot be medically justified, and so applications of X-rays are in direct contravention of IR(ME)R regulations which demands medical justification for all exposures. One has to wonder how chiropractors get away with X-raying patients. One factor must be is that statutory regulation of chiropractors directly lead to their inclusion in the list of health workers who were allowed to refer for X-ray. Not that means that their referral is likely to be justified.

Such are the perils of regulating nonsense.

Labels: BPSDB, chiropractors

 

Andy Burman, Chief Executive of the British Dietetic Association, appears to have resigned his post from the Complementary and Natural Healthcare Council (Ofquack).

This news follows my recent criticism on this site of the BDA for not doing enough to educate the public about the difference between pseudoscientific Nutritional Therapists (as to be 'regulated' by Ofquack) and professionally trained and regulated dietitians (as currently represented by the BDA). This came in the wake of the news that a brain damaged woman had been given £810,000 by the insurers of self-styled nutritionist Barbara Nash. I commented that the situation was being made worse by the emergence of the ill-conceived, government sponsored and Prince Charles driven, CNHC. Ofquack will not protect the public from the practices and commercial motives of Nutritional Therapists and will do nothing to improve the public understanding of nutritional science - indeed, it will substantially undermine it.

It was therefore something of a shock to read a comment left on my blog that said that Andy Burman, Chief Executive of the BDA, was on the board of directors of the newly emerging Ofquack. The commenter said, "Instead the management of the BDA is actively undermining their own members." My simple response was that the BDA was therefore doomed.

It would appear that I have poked a sharp stick into a dyke of sleeping dogs and unleashed a hornet's nest of discontented angry bear dietitians. What became clear, by further comments on my web site, was that many grass roots dietitians were livid about the situation. A selection of some of the comments follows:

I wonder how much time Dieticians spend disabusing the general public of some wacky notion they have picked up from non evidenced based nutritional practitioners?

Might as well all raise a white flag to McKeith, Holford et al and face the fact that evidence based nutrition is a dead duck.

Is the chief exec of the BDA further providing legitimacy to the very nutritional therapists that are a danger to the public and in doing so professionally humiliating his own members?
Yes.
Should dieticians now be demanding a change of direction and chief exec at the BDA or just abandoning the pointless organisation?
Yes.

I am a proud HPC registered Dietitian and up till recently I was also a proud member(albeit diminishing) of the BDA. However on discovering that my very own Chief Exec Andy Burman is, a member of the Complementary and Natural Healthcare Council's Federal Regulatory Council I am truly mad and embarrassed.

It looks like a storm was brewing. Indeed, Andy Burman appeared to feel it necessary to leave his own comment on my blog. In that comment, Mr Burman defended his role at Ofquack and the need for the organisation itself. Also, on his biography on the Ofquack website, he says,

Andy is committed to voluntary self regulation within complementary healthcare and honoured to be part of this new development.

This defense did not appease his critics. Further comments ensued.

I'm sorry - I find the response from the Chief Exec of the BDA beyond belief. How can you possibly maintain standards for stuff that doesn't work? All you will do is provide legitimacy to those practitioners who do not maintain the high standard of your own members (who, by the way - must be absolutely livid that you are choosing to tacitly support quack therapists by providing legitimacy to them via regulation).

Ladies and Gentlemen It's time to reclaim the place that is rightfully ours and maybe look at who we choose to represent us -because let's face it in any other business our PR agency would have been well and truly fired by now!

I'm also very concerned at the news about Andy Burman. Maybe we should be reviewing his position as CEO of the BDA.

I think Andy has made his position untenable - the membership is mad as hell. Those of us who work in the private sector have all dealt with clients that have seen these therapists - some of the rubbish they sprout is quite unbelievable. The new council I think is a sham - and the NTs themselves do not want any more reg because they will end up halfing their income from all the supplements they sell [The BANT code of 'ethics' explicitly allows Nutritional Therapists to take commissions on supplements they sell. - LCN]

The final comment today from an anonymous dietitician reads,

I understand that Andy Burman has resigned from OfQuack. Good news for dietitians.

Although, I have not has direct confirmation of this yet, it is backed up by the disappearance of his biography on the Ofquack web site (compare the current version with Google's cache). This was the very least that should have happened. It is obvious that some people believe that the involvement with Ofquack has undermined his role as Chief Executive at the BDA.

Ofquack was founded as a result of a monumental governmental mistake. The House of Lords, in 2000, recommended the government look into the proper regulation of alternative medicine. It was concerned that the public was not sufficiently protected from the alternative medicine trade and recommended that ways were sought to ensure practitioners were well trained, safe and effective in what they did. In an act of blazing naivity, the government saw fit to hand over this responsibility to Prince Charles and his bizarre organization, the Foundation for Integrated Health. The task defining what regulation should look like was handed over to the very people that cause the problem with their loony beliefs.

The result was predictable. FIH took to the task with gusto, forming important looking committees and consultations. The only thing dropped from the Lord's recommendations was the question of efficacy. Ofquack are only interested in showing that boxes can be ticked regarding training. It does not matter one iota that the practices of those they seek to regulate do not work.

Indeed, this was against the very wishes of the House of Lords. In their summary they said,

Many CAM therapies are based on theories about their modes of action that are not congruent with current scientific knowledge. That is not to say that new scientific knowledge may not emerge in the future. Nevertheless as a Select Committee on Science and Technology we must make it clear from the outset that while we accept that some CAM therapies, notably osteopathy, chiropractic and herbal medicine, have established efficacy in the treatment of a limited range of ailments, we remain sceptical about the modes of action of most of the others. We therefore emphasise that in recommending the regulation of training in CAM we specifically exclude training in the asserted modes of action of many CAM therapies. We do so because regulation could lead to a misleading public perception of improved status; such regulation is in fact an attempt to safeguard the public. (My emphasis)

It looks like our vestigial feudal wing of government can duly show wisdom and insight when required, even in the face of their overlord, Prince Charles. Magna Carta rocks.

Despite Prince Charles FIH’s stated commitment to evidence based alternative medicine being ‘integrated’ with real medicine they avoid the evidence base like the plague. They embrace nonsense healing rituals like homeopathy and reflexology without appearing embarrassed about the utter lack of credibility for these techniques. Just check out their site. Can you spot any alternative medicine that Prince Charles says to avoid because of its lack of a credible scientific evidence base? I can see no reason why the claims of nutritional therapists will not be treated in exactly the same manner. As long as they can claim to hold some sort of training they well get the Ofquack seal of approval. The content of that training will not be important.

Andy Burman, in my opinion, is making the same mistake that everyone in the sorry tale of Ofquack is making - that the way to protect the public is to regulate the trades of alternative medicine in the same manner that you might regulate real medicine. The flaw with this idea is that you cannot regulate nonsense. Professor David Colquhoun has demonstrated the central weakness of Ofquack in the THES and on his own blog (1) (2). Is a homeopath a safer practitioner because they have successfully completed the modules that teach them that illness is caused by imbalances in the Vital Force and that a medicine's effectiveness increases with more dilution? Does a Nutritional Therapist, after completing professional development courses in Hair Mineral Analysis or Allergy Testing offer a better service to their punters or allow them to fleece the public better with fraudulent pill selling techniques?

We do not provide astrologers and psychics with state money to set up their own self-regulatory bodies. Instead we allow existing mechanisms to ensure the worst of their practices are curbed by using the Advertising Standards Authority and Trading Standards to warn and prosecute where necessary. And it does not matter if a quack genuinely believes that reflexology foot massages can help you with constipation (or whatever). Many people genuinely believe pyramid selling schemes can get you rich. We do not offer accreditation and state regulation to the owners of pyramid schemes - no, we educate the public about their dangers and prosecute those who profit.

If we believe the public should have some protection from quacks, the answer is two-fold: public education and prosecution. Not accreditation and meaningless self-regulation that only serves to aggrandise. And in anycase, Ofquack is a dead duck and is doomed to whither, mainly because the quacks do not want to be regulated by any sort of outside body and self-regulation cannot compell them to become registered. In short, a monumental folly.

The BDA could and should be offering more public education. Every time there is some self-appointed and under-educated nutritionist on the day time television couches, the BDA should be ensuring the producers know what unstable ground they are on. In Germany, they fire TV nutritionists who spout nonsense and self-servingly promote their own quack products. We should be doing the same here. The BDA should be ensuring that the public see dietitians as the first port of call for dietary advice - not the last, after the nutritionists nuts have filled peoples' heads with dietary nonsense. And the BDA should be assisting the authorities where necessary to enforce existing advertising and trading standards legislation. The legislation is not perfect, but is a damn good start.

Can Andy Burman do an about turn and work with his colleagues at the BDA to this end? Let's hope so.

Labels: Natural Healthcare Council, nutritionist, ofquack, Prince Charles

 

Homeopathy on the NHS has nearly vanished. We see prescriptions have halved in the past two years and one of the last five hospitals has been confirmed to close. This is as it should be. The last vestigial remnants of nineteenth century quackery in the state health care system are being dropped from the tax payers burden. There is nothing unsurprising here. It is the natural result of an increasing awareness of the need to adopt evidence based practices. As much as quackbusters would like to think that it is their influence that has achieved this, I would guess what we are seeing is the result of more general and broader historical changes.

But the homeopaths, in their fabulously constructed fantasy world, see an army of quackbusters crossing the Vistula and are conspiring in their bunkers to strike back with what depleted reserves they have. We can expect to see increasing and bizarre attempts by homeopaths to bolster their position and smear their enemies.

The Faculty of Homeopaths, who represent medically trained homeopaths, has been hard at work. It has issued a press release reporting supposedly dramatic benefits for NHS homeopathy. 'Angry' Melanie Oxley, ex Society of Homeopaths, appears to be issuing press releases for the Faculty.

In one press release, she tries to discount reports that doctors are not prescribing homeopathic pills any more. She says there are three reasons:

Although balanced by increased patient numbers, the proportion of prescriptions actually written by a GP is not representative of the whole; other health professionals such as nurses and pharmacists have prescribing rights.

Of course, the Faculty do not appear to have any evidence that there is a massive shift to nurse based prescribing of homeopathy within the NHS. That would be fascinating in its own right.

The cost of buying a homeopathic medicine over the counter is often less than for a NHS prescription (prescription £7.10, homeopathic medicine typically less than £5.00). Increasingly, prescribers are recommending their patient buys the
remedy over the counter, saving the patient money.

This may well be true, but many people on long term illness, the young and the old, do not pay prescription charges anyway. Again, there is no evidence to support the assertion that doctors (or nurses) are asking patients to cough for their own sugar pills.

Only a tiny proportion of the 3,500 plus homeopathic medicines available are listed in the computer software for GPs, and so most homeopathic prescriptions are handwritten. It is not clear whether these are entered into the data.

Mmmm. The computer says, 'No'. Yes, there are thousands of remedies, but most prescriptions are undoubtedly for the common dozen you can find anywhere. Is the NHS really prescribing hyena saliva and Vacuum Cleaner Dust remedies? I doubt it.

The latest piece of rubbish to emerge from the Faculty is about a paper that has just been published from research at the Bristol Homeopathic Hospital in the Faculties comic, Homeopathy. This follows the appalling 'Spence' paper from Bristol that claimed to show that 70% of their patients reported health improvements. There were no control groups in this study. There was no evidence that homeopathy was the cause of the health improvements. It was rubbish and Bristol have not learnt the simple lesson.

This time we learn that "Nearly 60% of patients who had received a series of homeopathy appointments reported an improvement in health that affected their daily lives." Again, nothing to compare this figure to. No way of knowing what the health improvements would have been without homeopathy. We just find out the startling truth that some ill people get better. But this is unsurprising as the paper was about a pilot study to test methods in quality assurance in homeopathic hospitals. It is a way of conducting homeopathic customer satisfaction surveys and tells us nothing about the effectiveness of the magic sugar pills.

But being good PR people at the Faculty, the truth will not get in the way of a good story. The Daily Mail has already reported on this nonsense, The alternative Holby City that treats 30,000 patients a year.

The Mail says,

But with budgets in crisis, critics claim spending on complementary medicine is frivolous - and last week it was revealed that GPs' homeopathic prescriptions have fallen by 40 per cent in two years.

Yet according to the journal Homeopathy, among those receiving these remedies, 60 per cent say their health improved after treatment. We spoke to a range of patients at the hospital who have turned to homeopathy.

In other shock medical news, children who have visited hospital tend to grow taller over the following year. And so, the Mail trots out the anecdotes. In one hilarious one, a patient recounts the failure of homeopathy,

Dr Saul Berkovitz, who leads the clinic, put me on homeopathic remedies at first - causticum, which is supposed to help stiffness, and cimicifuga, which alleviates aches. Neither helped.

But never mind. Some chinese herbal medicine was the thing that 'worked for her' in the end. We also find out how Gertrude does not get colds anymore and how Joshua's childhood eczema cleared up. Also, in a remarkable testimony, Nike Jonah's headaches have been helped by real medicine, but now she has taken some homeopathy and is waiting to see if it works. And 95 year old Jane swears by arnica for her bruises. You could not make this stuff up.

The Faculty of Homeopaths are taking entirely the wrong track here. They are swimming against the current of science and reason. As the (relatively) sane wing of the homeopathy movement, the Faculty really ought to be having a frank discussion about the practicalities and ethics of using an entirely placebo based therapy in modern healthcare. That is what all the science and evidence says homeopathy is and that is the only discussion that could feasibly save homeopathy on the NHS. Can they muster the insight and courage to have that conversation?

Labels: homeopathy, NHS