Medical Hypotheses fails the Aids test

September 12th, 2009 by Ben Goldacre in africa, aids, bad science | 61 Comments »

Ben Goldacre, 12 September 2009, The Guardian

This week the peer review system has been in the newspapers, after a survey of scientists suggested it had some problems. This is barely news. Peer review – where articles submitted to an academic journal are reviewed by other scientists from the same field for an opinion on their quality – has always been recognised as problematic. It is timeconsuming, it could be open to corruption, and it cannot prevent fraud, plagiarism, or duplicate publication, although in a more obvious case it might. The problem with peer review is, it’s hard to find anything better.

Here is one example of a failing alternative. This month, after a concerted campaign by academics aggregating around websites such as Aidstruth.org, academic publishers Elsevier have withdrawn two papers from a journal called Medical Hypotheses. This academic journal is a rarity: it does not have peer review, and instead, submissions are approved for publication by its one editor.

Articles from Medical Hypotheses have appeared in this column quite a lot. They carried one almost surreally crass paper in which two italian doctors argued that “mongoloid” really was an appropriate term for people with Down syndrome after all, because they share many characteristics with oriental populations (including: sitting cross legged; eating small amounts of lots of different types of food with MSG in it; and an enjoyment of handicrafts). You might also remember two pieces discussing the benefits and side effects of masturbation as a treatment for nasal congestion.

The papers withdrawn this month step into a new domain of foolishness. Both were from the community who characterise themselves as “Aids dissidents”, and one was co-authored by their figureheads, Peter Duesberg and David Rasnick.

To say that a peer reviewer might have spotted the flaws in their paper – which had already been rejected by the Journal of Aids – is an understatement. My favourite part is the whole page they devote to arguing that there cannot be lots of people dying of Aids in South Africa, because the population of that country has grown over the past few years.

We might expect anyone to spot such poor reasoning – and only two days passed between this paper’s submission and acceptance – but they also misrepresent landmark papers from the literature on Aids research. Rasnick and Duesberg discuss antiretroviral medications, which have side effects, but which have stopped Aids being a death sentence, and attack the notion that their benefits outweigh the toxicity: “contrary to these claims”, they say, “hundreds of American and British researchers jointly published a collaborative analysis in The Lancet in 2006, concluding that treatment of AIDS patients with anti-viral drugs has ‘‘not translated into a decrease in mortality” [30].”

This is a simple, flat, unambiguous misrepresentation of the Lancet paper to which they refer. Antiretroviral medications have repeatedly been shown to save lives in systematic reviews of large numbers of well-conducted randomised controlled trials. The Lancet paper they reference simply surveys the first decade of patients who received HAART – modern combinations of multiple antiretroviral medications – to see if things have improved, and they have not. Patients receiving HAART in 2003 did no better than patients receiving HAART in 1995. This doesn’t mean that HAART is no better than placebo. It means outcomes for people on HAART didn’t improve over an 8 year period of their use. This would be obvious to anyone familiar with the papers, but also to anyone who thought to spend the time checking the evidence for an obviously improbable assertion.

What does all this tell us about peer review? The editor of Medical Hypotheses, Bruce Charlton, has repeatedly argued – very reasonably - that the academic world benefits from having journals with different editorial models, that peer review can censor provocative ideas, and that scientists should be free to pontificate in their internal professional literature. But there are blogs where Aids dissidents, or anyone, can pontificate wildly and to their colleagues: from journals we expect a little more.

20 academics and others have now written to Medline, requesting that Medical Hypotheses should be removed from their index. Aids denialism in South Africa has been responsible for the unnecessary deaths of an estimated 330,000 people. You could do peer review well, or badly. You could follow the single editor model well, or foolishly. This article was plainly foolish.


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61 Responses



  1. Muero said,

    September 12, 2009 at 1:05 am

    In my whole life I’ve never seen AIDS written as “Aids.” Is that some weird British thing? Also, I can’t find anything that is really called “Journal of Aids” anywhere. Do you mean the Journal of Acquired Immune Deficiency Syndromes?

  2. jdc said,

    September 12, 2009 at 1:28 am

    Was reading the ‘peer-reviews’ on the Denying Aids blog earlier. Having provided mirth to many, I think that Medical Hypotheses is perhaps now beyond a joke.

  3. Pro-reason said,

    September 12, 2009 at 2:42 am

    Muero, since we’re writing in and talking about the English language, ‘weird British thing’ is nonsensical.

    It is normal for acronyms to come to be written in lower case over time (think of ‘laser’). This distinguishes acronyms from initialisms.

    Goldacre seems to be following the Guardian Style Guide (www.guardian.co.uk/styleguide/a) which mandates the use of ‘Aids’.

    That said, I don’t the word is quite there yet. I still prefer ‘AIDS’.

  4. Pro-reason said,

    September 12, 2009 at 3:15 am

    Hey, this article has prompted me to learn something: people with Down’s Syndrome, apes, and also people with a certain gene, all have a single crease across their palm, instead of the usual two creases. I have a simian crease too! I’m so ‘special’!

    Come to think of it, I have quite almond-shaped eyes for a European. OK, I’m a Mongol and proud! I can almost feel the blood of Genghis Khan pulsing in my veins…

  5. Yoss said,

    September 12, 2009 at 4:13 am

    I have left a comment on the guardian version of this article containing an interesting example of peer-review-gone-bonkers. I will repeat it here (cos it’s that interesting):

    An extreme but interesting case was that of the peer-reviewed journal: Chaos, Solitons and Fractals, which published much psuedo-science and mumbo-jumbo by its editor El Naschie (who has now retired) and a few other fruitcakes who presumably reviewed his papers, along with a few good quality articles by other authors who presumably were not sufficiently familiar with the journal to know it was mostly rubbish.

    see: scintilla.nature.com/node/579389

  6. SubMoron said,

    September 12, 2009 at 12:28 pm

    The trouble, as said above, is that unrefereed papers (to use the older term) will be quoted by those who should know better and lower the signal/noise ratio still further.
    Does anyone have a solution which doesn’t look like being labelled as a conspiracy?

    Pro-reason; I have a simian fold on my right hand and a homonid fold on my left hand. It’s useful when dealing with “black people/ape” racists. I’m an African ape and proud of it!

  7. Bruce G Charlton said,

    September 12, 2009 at 2:12 pm

    This is Bruce G Charlton – I am the editor of Medical Hypotheses.

    I believe Ben Goldacre misrepresents the issue here. The issue is not about whether editorial review is superior to peer review, but whether alternatives to peer review should be allowed to exist at all.

    At present there is an organized campaign to destroy Medical Hypotheses, and to enforce a rule where _all_ journals _must_ be peer reviewed in all respects. Here are the relevant links:

    www.aidstruth.org/news/2009/elsevier-retracts-duesberg%E2%80%99s-aids-denialist-article

    And this is the specific letter [reference 7] aiming to de-list Medical Hypotheses (and all similarly editorially-reviewed journals) from Medline, and thereby destroy all accessible alternatives to peer review:

    www.aidstruth.org/sites/aidstruth.org/files/NLMLetter-2009.08.05.pdf

    This letter is full of errors (for example it says that Medical Hypotheses consists only of Editorials and Letters – whereas by far the bulk of the journal is full length articles).

    However, the weirdest thing about the attack in this letter is that Medical Hypotheses is being slammed for being successful and efficient.

    Under my editorship, and with most published papers reviewed only by me (and chosen on the basis not that they were true but were bold, potentially interesting, or even if largely wrong may be able to provoke useful discussion); I have been able to expand the size of the journal by about 50 percent, while increasing the impact factor from a mediocre 0.6 to a respectable 1.4 – and achieved half a million article downloads per year (which is very high usage – about the same as the Journal of Theoretical Biology) – and all this has been done with a review process that gives a decision to most authors in about 1 week.

    If Ben G is under the impression that editorial review ‘missed’ things about these two AIDS papers that peer review would have picked up – he is mistaken. These papers were deliberately published for reasons explained on the Medical Hypotheses web pages:

    www.elsevier.com/locate/mehy

    It is trivially-easy for an editor to exclude dissenting papers, or papers that are likely to be regarded as wrong, or papers that are mostly wrong but contain some important points – if exclusion is what the editor wishes to do, or if the editor believes that only wholly-correct (according to peer consensus) papers ought ever to be published. But there are other reasons why papers ought to be published – and one reason is that the ideas are being suppressed and another is that even flawed papers may contain ideas well worth thinking-about or discussing.

    Instead of celebrating the objectively measurable success and efficiency of an alternative model to peer review for running a journal, the reaction from some people is that Medical Hypotheses ought to be closed, or changed beyond recognition, because it does not conform to the standard _process_ for evaluating papers. This is not judgment by results, but merely judgment of procedure.

    I am sorry to observe that Ben Goldacre seems to have taken sides with those who believe in the suppression of ideas, rather than exposing ideas to critique (and perhaps refutation) in the scientific literature; he also seems to have taken sides with those who wish to enforce a monopoly of peer review in scientific journals.

    As things are trending, it looks as if Medical Hypotheses will either be shut-down or forced to become yet another orthodox and peer reviewed journal.

    I would be grateful if those who would like to prevent this outcome, and who supported the mission of Medical Hypotheses, might mail me with their comments at editormehy@yahoo.com – and I will (if they wish) forward these comments to the publishers.

  8. Bruce G Charlton said,

    September 12, 2009 at 3:58 pm

    As the editor I am ‘agnostic’ about the truth or correctness of the papers chosen for publication in Medical Hypotheses, so I make no comment on that aspect of the AIDS papers.

    Instead I aim to decide what ought to be published according to the criteria applied by Medical Hypotheses – which can be seen here – www.elsevier.com/locate/mehy .

    Clearly these two AIDS papers ought to have been published by the journal’s evaluation criteria, and the reaction since they were accepted shows exactly why it was right that they were accepted to be published.

    Instead of working within the scientific process, for example by submitting a reasoned rebuttal to Medical Hypotheses of the kind which we always publish, the authors who are trying to destroy Medical Hypotheses wrote to the _publisher_ of the journal and succeeded in getting these papers suppressed and deleted from the records.

    www.aidstruth.org/sites/aidstruth.org/files/NLMLetter-2009.08.05.pdf

    These authors then wrote to try and de-list Medical Hypotheses from Medline, an act that would exclude the journal from the mainstream scientific communication network in which – at present – it plays a significant role (significant, that is, according to objective data on impact factor, citations and downloads).

    Such behind-the-scenes action to exclude dissenting views – operating out-with the open scientific fora, and via publishers not journals – has never been characteristic of the admired practice of serious scientists.

    Indeed, most serious scientists would be deeply ashamed to be known to behave in this fashion.

  9. mrmuz said,

    September 12, 2009 at 10:13 pm

    I wonder if there’s enough weird stuff published in med journals to warrant a ‘Publishing Be Damned’ blog of the things people dig up. Akin to those sites that find bizarre patents, hideous houses for sale or bad photoshop.

  10. TeeD said,

    September 13, 2009 at 2:51 pm

    The misrepresentation of that Lancet study is even worse than you suggest here.

    “The Lancet paper they reference simply surveys the first decade of patients who received HAART – modern combinations of multiple antiretroviral medications – to see if things have improved, and they have not.”

    They actually have improved, it’s just that the initial paper only followed people for the first year of treatment, and the proportion of people who became ill or died during the first year of treatment was too low to detect any difference between 95/96 and 2002/3. The same researchers have since published follow-up out to three years on treatment for the same cohorts, and people receiving more modern combinations are doing significantly better. This explanation from the comments on the Guardian is worth reposting here I think:

    “The lack of a “decrease in mortality” that is being referred to in that quote involves a comparison of mortality AFTER JUST ONE YEAR ON TREATMENT among people who started treatment in 95/96 compared to people who started in 2002/3.

    Mortality after one year of treatment in 95/96 was 2.2% (27 deaths out of a cohort of 1,232 people) and in 2002/3 it was 1.3% (25 deaths out of a cohort of 1,932 people). This is not a statistically significant difference. BUT IT IS NOT A COMPARISON OF TREATMENT vs. NO TREATMENT.

    The study also included measurement of HIV viral load six months after starting treatment, and the proportion of people with viral loads less than 500 copies at this timepoint increased from 58% in 95/96 to 83% in 2002/3. Given that there is still a significant proportion of people who did not achieve a viral load this low in the more recent period (17%) and given that mortality after one year of treatment was much lower than this (1.3%) it is not particularly surprising that this overall improvement in virological response “has not translated into a decrease in mortality” AFTER JUST ONE YEAR ON TREATMENT.

    What would be expected based on the published literature is that the improvement in virological response in the more recent period would lead to better long-term outcomes. And indeed this is the case. The Lancet paper includes a supplemental table with two-year follow up; far fewer people get diagnosed with AIDS or die in their second year on treatment and the differences between 95/96 and 2001 (the most recent period with two-year follow-up available) get wider: 2 year mortality in 95/96 is 4.3% vs. 2.5% in 2001.

    In 2008, the same authors published three year follow up for the same cohorts: The Lancet, Volume 372, Issue 9635, Pages 293 – 299, 26 July 2008

    “Findings: 18 587, 13 914, and 10 854 eligible patients initiated combination antiretroviral therapy in 1996—99, 2000—02, and 2003—05, respectively. 2056 (4·7%) deaths were observed during the study period, with crude mortality rates decreasing from 16·3 deaths per 1000 person-years in 1996—99 to 10·0 deaths per 1000 person-years in 2003—05.”

    This reduction in mortality in the more recent period is significant.

    These papers also show that the rate of AIDS events in the second year people are on treatment is much lower than the first e.g. for the 1,232 people who started treatment in 95/96 the difference was 103 AIDS events in the first year and 32 in the second. For 1,932 people who started treatment in 2001 the difference was 172 AIDS events in the first year versus 27 in the second.”

  11. IMSoP said,

    September 14, 2009 at 12:27 am

    On the “AIDS”/”Aids” thing, it’s standard Guardian style to write *any pronounceable acronym* with an initial capital only, presumably because it breaks up the visual flow of the page less than ALL CAPS would:

    “Use all capitals if an abbreviation is pronounced as the individual letters: BBC, VAT etc; if it is an acronym (pronounced as a word) spell out with initial capital, eg Nasa, Nato…”

    [ www.guardian.co.uk/styleguide/a#id-2829413 ]

  12. Bruce G Charlton said,

    September 14, 2009 at 10:31 am

    I am the editor of Medical Hypotheses.

    I notice that my comments (numbers 7 and 8 above) are not publicly visible unless the reader is logged in – is this because they have not yet been moderated, or for some other reason?

  13. ajberrow said,

    September 14, 2009 at 12:21 pm

    Bruce G Charlton, which numbers 7 & 8 do you refer to? The 7 & 8 I can see are from mrmuz and TeeD respectively – logged in or not.

  14. Ben Goldacre said,

    September 14, 2009 at 12:42 pm

    hi bruce you triggered the spam filter and i was at a festival

  15. Ben Goldacre said,

    September 14, 2009 at 12:46 pm

    bruce: it’s great to have high ideals about what Medical Hypotheses can achive with its editorial model, but please can you tell me what possible justification there is for publishing an article which misrepresents a key reference, that Lancet paper described, in such a way? this isn’t a matter of perspective, or free expression of ideas, and it’s not a disagreement of interpretation: it is a simple error of fact, they just misrepresented a key reference. what is your justification for publishing that, and how does it fit into any kind of meaningful vision that can help ideas be disseminated and improved?

  16. Seth Kalichman said,

    September 14, 2009 at 1:14 pm

    Dr. Charlton

    Goldacre has it right.

    I am Seth Kalichman, one of the scientists who signed the letter calling for retraction for retraction of the Ruggiero and Duesberg articles from Medical Hypotheses.

    If scientists were the only consumers of scientific literature, and if a single editor could know everything, then perhaps your alternative to peer review would be reasonable. But neither is the case.
    Your publishing the Ruggiero and Duesberg articles is just the latest example of why your approach to editing is not only a failure but also harms public health.

    Today everyone has access to all published research. Access is a good thing and should only be expanded further. However, knowing that a person who is recently diagnosed with cancer, diabetes, or HIV infection is just as likely to read your journal as a medical researcher raises the bar for quality control and clarity of presentation.

    Worse yet, you afford AIDS denialists and other pseudoscientists opportunities to present themselves as credible when they are not. One of the authors on the Duesberg article is Henry Bauer, a self-proclaimed international expert on the existence of the Loch Ness Monster. Will we soon see an article on proof of Nessies in Medical Hypotheses?

    One person, no matter how broadly trained, cannot make the call on every paper. The Ruggiero and Duesberg articles were accepted by you within days, perhaps hours, of receipt. If your decisions were guided by expert opinions you would be less inclined to make such horrific errors in judgment. To be sure, peer review is not perfect, but it far better than the beliefs of any one of us. I recently conducted a simulated blind review of the Duesberg article. The reviews I received are posted at my blog and would certainly inform any reasonable editor that the paper was a sham.

    My hope is that you either change your policy or that Elsevier replace you as Editor, or perhaps do away with the journal altogether.

    Seth Kalichman
    denyingaids.blogspot.com

  17. Bruce G Charlton said,

    September 14, 2009 at 2:01 pm

    @ Ben Goldacre: “bruce: it’s great to have high ideals about what Medical Hypotheses can achive with its editorial model, but please can you tell me what possible justification there is for publishing an article which misrepresents a key reference, that Lancet paper described, in such a way?”

    BGC replies: I’m sorry if I am just repeating myself – but the criteria for evaluation used by Medical Hypotheses are stated at the top of the journal’s home page:

    www.elsevier.com/locate/mehy

    [excerpt] “…editorial selection works within constraints of subject matter on the basis of factors such as potential importance and interest, clarity and appropriateness of expression, and broad criteria of scientific plausibility. Even probably untrue papers may be judged worth publishing if they contain aspects (ideas, perspectives, data) that are potentially stimulating to the development of future science.”

    These are not “high ideals” – this is simply how Medical Hypotheses is edited.

    The editorial review method is clearly stated and referenced to my piece in the BMJ from which the above quote was taken.

    medicalhypotheses.blogspot.com/2007/09/peer-usage-versus-peer-review.html

    And the title of the journal makes matters crystal clear – I would have thought: Medical _Hypotheses_.

  18. Dr. S said,

    September 14, 2009 at 3:07 pm

    While there appears a significant issue with this particular incident, Ben Goldacres post overstates the case. Medical Hypotheses has been running for three and a half decades with a generally high impact factor, giving interesting and valuable counterpoint to many aspects of the Medical Sciences. Any journal is capable of error from time to time, and as Goldacre notes, the peer review system is in no wise a guarantor of perfection, or even a constant guardian against serious error. To condemn this venerable and unique institution to the dustbin on the basis of a single controversy makes one wonder if Dr. Goldacre has a particular dislike for this journal and an interest in its demise quite apart from the particular incident here discussed.

  19. Michael Grayer said,

    September 14, 2009 at 3:55 pm

    Bruce, I can fully see and appreciate the ideals that Medical Hypotheses aspires to, but does it really fulfil those goals? If you were to take a long look back at the articles that have appeared in the journal, do we really see a breeding ground for radical new ideas that have now been tested and accepted into regular medical practice, or do we see more of the collateral effect of allowing quacks to have a publication repository thus conferring a false sense of respectability on their “work”?

    I have little personal experience of Medical Hypotheses, apart from when I recall investigating the claims of the “medical director” (or somesuch) of a quack healthcare group that he had a long publication record of over 200 articles. A quick Google Scholar search revealed that the vast majority of these were published in Medical Hypotheses.

    While Elsevier does publish some very respectable journals (from my field, The Lancet and Social Science & Medicine spring to mind) it also has a track record of publishing some not very respectable ones.

    If Medical Hypotheses does have a genuine place in medical literature then I would like to see some example of what Dr. S calls “interesting and valuable counterpoint to many aspects of the Medical Sciences”. The theoretical benefit is clear – but does this translate into any meaningful benefit in practice? My current impression is that the highly erroneous (and dangerously misleading) article Drs Goldacre and Kalichman cite in this article and in the comments is not an isolated case and it is charlatanry that permeates the pages of the journal rather than life-saving ideas that would otherwise have gone unreported.

    I would be interested in seeing some counterexamples though.

  20. CampFreddie said,

    September 14, 2009 at 4:11 pm

    I’m not a doctor. But I do use Medline to search for interesting articles on chemical compounds (usually metabolites or impurities in chemical processes). I use it as one of several methods to check for any toxicological problems that might need some further study.

    I don’t expect every article to be perfect (I’ve seen more than a few dubious claims in peer-reviewed journals), but I do expect some basic fact checking. I am shocked that a medline-referenced journal can have little fact-checking beyond the time it takes to realise, “This looks interesting, will boost my impact factor and get some news headlines”.

    Checking that the main references really say what they’re claimed to is something that I expect from any serious journal, regardless of other aspects of editorial policy. Perhaps if the editor of Medical Hypotheses did his job properly, then the single-editor model might find more favour.

  21. Ben Goldacre said,

    September 14, 2009 at 4:20 pm

    hi bruce,

    really – really really – as i’ve said before, and as you know i’ve said before, i think yours is a good mission statement.

    however i do think there is an extremely important line to be drawn here, and i dont think anyone’s said it better than scott, with his “comment is free but facts are sacred”.

    if you want to print wild pontification by people then of course that’s great (although i don’t see why it needs to be a journal, given that there are plenty of places like blogs for people to do that, especially if fact checking standards in the journal are as demonstrably low as we’ve seen here).

    if you want to print wild pontification by aids denialists then fine, i think a bit of thought should go into the potential repercussions, as i understand it you don’t because you think other ideals are more important, that is a fair disagreement.

    but this aids paper was not in any sense useful scholarship. i dont see the point of an academic paper wherein i read a sentence saying that a lancet paper has shown aids drugs dont work, and then i read the paper to which it refers and find out this was a complete misrepresentation of the paper’s nature and findings. i just dont see how that’s in any way valuable or interesting to anybody. could you answer on that specific point? i’d really like to hear your views on that level of factual distortion, even though i know you are trying to maintain a principle of not talking about an individual paper, because i feel we’re talking in the abstract a little here in a way that is allowing the point to be somewhat elided.

    “Dr S”: I am slightly surprised to see you making dark allusions about undeclared motives, i just think some of these various Med Hyp articles are very problematic (and i write a lot about problematic articles in a lot of places). however can i refer you to the “rules” for this site which i think are very reasonable: i do feel that having raised the issue you should clarify your own relationship to this issue, and remind you that if you don’t, i may.

    www.badscience.net/how-to-use-this-website/the-rules/

  22. Bruce G Charlton said,

    September 14, 2009 at 4:57 pm

    @Ben Goldacre said: “could you answer on that specific point? i’d really like to hear your views on that level of factual distortion, even though i know you are trying to maintain a principle of not talking about an individual paper”

    You are correct. I am not going to talk about any individual paper; beyond stating that Medical Hypotheses (unlike many other journals) “does exactly what it says on the tin”.

    Clearly some people object to the mission of MeHy i.e. they disagree with what is said on the tin, and would prefer the tin said something else.

    But I would like to consider some of the current members of the Editorial Advisory Board who _do_ support the mission of Medical Hypotheses:

    en.wikipedia.org/wiki/Arvid_Carlsson

    en.wikipedia.org/wiki/Roy_Calne

    en.wikipedia.org/wiki/Antonio_Damasio

    en.wikipedia.org/wiki/Vilayanur_S._Ramachandran

    The MeHy Horrobin Prize for 2008 was awarded by:

    en.wikipedia.org/wiki/David_Weatherall

    Past members of the board have included:

    en.wikipedia.org/wiki/Karl_Popper

    en.wikipedia.org/wiki/James_W._Black

    These are scientists and thinkers of real achievement.

    So to those who are absolutely sure that Medical Hypotheses is worthless and could be destroyed without loss to medical science, I would follow Jacob Bronowski in quoting Oliver Cromwell:

    “…think it possible you may be mistaken”!

  23. Dr. S said,

    September 14, 2009 at 5:43 pm

    So, Ben, you are “surprised” by what you describe as “dark allusions to undeclared motives”? Well, this is in itself rather surprising, as the reason for my suspicion is to be found between pages 157 and 159 of your recent book. In these pages you scurrilously attack the reputation of my father with nothing whatever so much as “dark allusions to undeclared motives”. In the process, you further insult my father’s memory by entirely failing to refer to him by his academic titles, or reference in any way his extremely extensive peer-reviewed scientific publications and contributions, making it appear that he was a mere profiteering businessman. (In fact his wealth was solely based upon his on-paper minority shareholding in the company, and any company profits were relentlessly plowed back into further research, at his insistence.) This in a book in which you painstakingly skewer individuals for either their lack of credentials, or the shaky ground on which they stand, and in despite of the fact that my father began his extremely distinguished professional career teaching at the very college from which you gained your degree. While never outright declaring it, you insinuate that he was merely a charlatan whose motivation was pure profit.

    While I happen to agree with many of the other aspects of your book, particularly those on homeopathy, I find it ironic that you are so sensitive concerning the subject of “dark allusions to undeclared motives” when you are yourself profiting so handsomely by their propagation (see plug on upper left of page).

    My father of course founded Medical Hypotheses, and so you will forgive me if I sense a rather other motivation for your attacks on this publication.

    As to the particular sequence of events in question, I have no involvement with the journal presently, and am not intimately aware of the sequence of events which have led to the present furore. From what I have read here, and given the often damaging history of effects that the questioning of mainstream views on AIDS has occasioned, I would indeed feel uneasy about such a publication. However my commentary acknowledged this, and rather concerned your apparent desire to bring about the destruction of yet another aspect of my father’s legacy.

    Dr. S. Horrobin

  24. misterjohn said,

    September 14, 2009 at 5:43 pm

    It seems to me that Bruce Charlton is using the excuse of not discussing an individual paper as a method of dissimulation. Ben Goldacre has not said that “Medical Hyptheses” is worthless. Certainly the article he wrote about is worse than worthless.
    And Bruce, the man who is so good at medical science that he alone can determine which articles he wants to publish, even apparently after merely glancing at them, I refer you to the remark about “motes and beams”, which Cromwell was probably familiar with. “By the bowels of Christ..”

  25. Seth Kalichman said,

    September 14, 2009 at 5:59 pm

    Dr. Charlton
    Elsevier’s retraction of the Duesberg article did not say much. Obviously Elsevier decided the paper could do more harm than good. Retraction is quite an unusual and extreme step.
    Can you please share what you were told by Elsevier as a basis for the retraction? I think readers of Medical Hypotheses can benefit from knowing the threshold for ideas worth publishing, at least from the publisher’s perspective.

  26. Ben Goldacre said,

    September 14, 2009 at 6:02 pm

    thank you Dr S Horrobin. this is a serious and concerning episode around two profoundly flawed pieces of work by aids denialists which have resulted in Elsevier forcibly withdrawing two articles and reviewing editorial processes at the journal. i think it’s fairly clear that i’m not writing critically about these aids denialist pieces as part of a personal issue regarding anyone – i’d not given Horrobin a moments thought, but for those who are interested, David Horrobin is discussed in the two links below. it is interesting to note that a man regarded by many as a snake oil salesman, who invented many of the techniques which are still so widespread today for marketing food supplement pills directly to the public, through the media, in the absence of sound evidence, was also the founder of Medical Hypotheses:

    www.independent.co.uk/news/obituaries/david-horrobin-730218.html

    www.badscience.net/2006/09/big-pharma-and-pill-peddlers/

  27. Ben Goldacre said,

    September 14, 2009 at 6:08 pm

    Hi Bruce

    i think your efforts to reframe this as a discussion about freedom of expression of ideas lacks credibility, and i’m concerned by your reluctance to discuss your journal’s policy on printing things that are simply factually inaccurate and misleading. as i said, a paper which misrepresents a paper to the extent that this duesberg paper misrepresents that key lancet reference is entirely useless, it’s not progressive scholarship, it’s simply misleading and untrustworthy.

    under other circumstances you would join me, i am sure, in not being moved by a list of authoritative figures on a journal’s editorial board.

    i am grateful to others for repeatedly pointing out to you that i am not, as you continually assert, arguing for the journal to be closed down, or indeed against your model.

    to return to what i regard as one of the most important issues here, at present you seem to be defending publishing articles which contain claims which are factually incorrect, and misrepresent the content of references. please can you clarify on this for us, either as a matter of journal policy, or your own view.

  28. Dr. S said,

    September 14, 2009 at 7:31 pm

    Ben,

    Good of you to show usual form, with vague hand-waving accusations and selective references, including self-reference, in order to slander a man highly respected by very many indeed, as evidenced by the extraordinary response to the BMJ obit (a journal which had formerly accepted many of his papers for publication during his lifetime). You can’t help yourself, it seems. There were of course several very positive obituaries, including in the Lancet, another journal which published very many of his papers, including one merely weeks before he died. A funny sort of snake-oil-salesman that uses his own supplements constantly and feeds them to his children (yes, I took them myself from the age of five), and has several hundred scientific papers published in dozens of journals- didn’t they know he was only a “snake oil salesman”, all those scientific reviewers? A curious sort of “snake oil salesman” that works on publications and scientific endeavour in his hospital bed until days before he dies. That smacks of real underhanded self interest, I am sure.

    As does of course the fact that the original Editorial Board of Medical Hypothesis included no less than three Nobel Prizewinners. All taken in by his underhanded designs, of course.

    Your lack of knowledge of the man is both pitiful, and ugly. But I am certain that it is proving very profitable to yourself.

    Dr. S. Horrobin

  29. Ben Goldacre said,

    September 14, 2009 at 7:42 pm

    hi s horrobin. i don’t think anyone would doubt that david horrobin did other things beside being a very successful snake oil salesman, like many successful snake oil salespeople. the concerns i have raised about his commercial activities – specifically using the media to disseminate distorted evidence on the efficacy of his food supplement pills to the public – are not handwaving, they’re set out very clearly, and they are shared by many. i’m sorry that you find them offensive, really, and i dont know how to say that any other way, but these are criticisms of an influential commercial figure’s high profile business activities that i very much stand by, and which should be discussed, in order to help us understand the kinds of things we see in the world around us today.

  30. Dr. S said,

    September 14, 2009 at 7:44 pm

    Ben,

    Furthermore, There was never any serious controversy surrounding Medical Hypotheses during the many years of my father’s editorial tenure, so in future please keep your obviously intractable tendency to make “dark allusions” of unfathomable guilt by association in check. Though I must thank you for increasing the irony of your own accusation.

    Dr. S. Horrobin

  31. Dr. S said,

    September 14, 2009 at 7:49 pm

    Ben,

    The manner in which you chose to discuss them was absolutely biased in the extreme. See my second post for examples. My father was no “snake oil salesman”, and your repetition of the phrase is ugly slander. Whether you or anyone else disagreed with the science he helped to pioneer, it remains a solid branch of human physiology and biochemistry, and one in which he believed utterly. “Snake oil salesmen” are simple frauds who attempt either successfully or no to sell products they know to have no efficacy to an unsuspecting public. The term does not and cannot describe my father, and your continued use of it merely serves to desecrate the memory of a man no longer able to defend himself, but one who was publishing research in peer reviewed journals before you were conceived.

  32. Dr. S said,

    September 14, 2009 at 7:51 pm

    Ben,

    In case you are interested, a link to the Lancet Obit, though I am sure that you will never use it, as it does not accord with your slanderous agenda:

    www.isad.org.uk/pdf/Horrbinobituary.pdf

  33. Ben Goldacre said,

    September 14, 2009 at 7:56 pm

    hi, thanks for the link.

  34. Dr. S said,

    September 14, 2009 at 7:56 pm

    Ben,

    A further link to the ISI site where he is listed as a “highly cited Scientist”, with a link to 883 of his publications, the majority of which are hypertexted:

    hcr3.isiknowledge.com/formViewCharacteristic.cgi?table=Publication&link1=Search&link2=Search%20Results&link3=Biography&id=2464

  35. Seth Kalichman said,

    September 14, 2009 at 8:17 pm

    Ben, I am not sure who to believe on this Horrobin situation…You, BMJ, or his son?

    Elsevier appers to have a consistent track record of sham editors at Medical Hypotheses…

    www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1125787

    To balance the Lancet Obit…
    The General Medical Council recently found Dr Goran Jamal guilty of research fraud (BMJ 2003;326:730). Twelve years ago he had falsified clinical trials of the drug Tarabetic, also known as Efamol, for a now-defunct company called Scotia. He had been promised a 0.5% royalty on sales, which was described as “highly unusual.” This may throw a light on Scotia’s way of working, for in its 10 year existence it obtained medicinal licences for only three products: Efamast for benign breast pain, Efalith for seborrhoeic dermatitis, and Epogam for atopic eczema. The licences were later withdrawn because the stuff didn’t work. The products contained evening primrose oil, which may go down in history as the remedy for which there is no disease, and David Horrobin, Scotia’s former chief executive, may prove to be the greatest snake oil salesman of his age.

    He founded and edited two journals, Medical Hypotheses and Prostaglandins, Leukotrienes and Essential Fatty Acids. He published 800 papers, many, it must be said, in his own journals. Few of them had enormous impact.

    With all due respect to his loving son, Elsevier should kill the journal Horrobin founded.

  36. Ben Goldacre said,

    September 14, 2009 at 8:22 pm

    it’s worth pointing out that after that BMJ obit, the journal also published an apology making it clear that the content was correct, but that they also recognised that being critical of someone’s activities so soon after they died may be insensitive. i think this is probably right, although as i’ve said, there is very definitely a legitimate need for these issues to be discussed. there was also an unsuccessful PCC complaint.

  37. Seth Kalichman said,

    September 14, 2009 at 8:29 pm

    Insensitive?
    Let me go on record to say that I will be happy to write the obit for Duesberg / Rasnick / Bauer and I will be happy to deliver as fast as Bruce Charlton can accept a paper for Medical Hypotheses…that would be in minutes.
    Seth Kalichman
    denyingaids.blogspot.com

  38. Dr. S said,

    September 14, 2009 at 9:14 pm

    Seth,

    I am not defending the situation with regard to Duesberg, nor referring to it.

    However you choose to print copy from the only really negative obit on my father, which was stunningly inaccurate (no less than 29 factual errors) and generated more outraged and dissenting responses than any other article published in the history of the BMJ. The apology was as graceless as the Obit was itself. Please see the responses, including many from distinguished scientists:

    www.bmj.com/cgi/content/extract/326/7394/885

  39. Dr. S said,

    September 14, 2009 at 9:22 pm

    Seth,

    After all, do you not consider it odd that my father had many publications accepted by the BMJ while he was alive, without a peep, and that the obit was written by someone who may well have had a personal axe to grind? An odd admission from such a respected journal, that they published numerous papers written by a “snake oil salesman”? Really this nonsensical slander must stop. I ask you kindly to spend a few minutes reading through his scientific publications list, linked above, before commenting again.

  40. DavidN said,

    September 14, 2009 at 11:04 pm

    I have a graduate degree in Anthropology, and am an evangelical supporter of your website.

    Humanities Grads are not all bad, please stop saying so. I volunteer as a medical interpreter…without language grads this work would not be done and languages are humanities subjects!

    At my university (top nz uni) I could see little support for pomo nonsense apart from one english lecturer. Even in the Anthro department, which is a notoriously borderline area.

    Anyway, keep up the great work! I’m sure I refer hundreds of new readers to your site. My ex boyfriend’s mother has finally renounced homeopathy/naturopathy as a result!

  41. Seth Kalichman said,

    September 14, 2009 at 11:26 pm

    Dr. S
    I have no interest in jerking you around about your late Father. The BMJ Obit was the first that popped on a Google search. A quick pubmed search finds a mixed bag of comments and letters, papers in journals he edited, and some in what are likely respected places. I am sorry if I offended you.
    The problem is the current management of the journal your father founded started. I do not believe we can blame your father for the failures of the current editorial process. Today’s Medical Hypotheses should be a newsletter for some society or association. It has no place in the leading indexes. Elsevier should either replace the editor and revamp the journal or discontinue it. Impact factor alone is not a reason to keep a journal alive. Impact factors are easily manipulated. I would be interested in the self-citation rate of Medical Hypotheses. “Self-cited rate is the ratio of a journal’s self-citations to the number of times it is cited by all journals including itself. Self-citing rate relates a journal’s self-citations to the total references it makes.” www3.interscience.wiley.com/journal/118935360/abstract?CRETRY=1&SRETRY=0
    The Duesberg and Ruggiero papers are just 2 examples of the failings of Medical Hypotheses. I see the value of a journal that publishes novel ideas that can push the field forward and challenge the status quo. I do not buy Charlton’s argument that the best way about this is an autocratic editorship. Bogus and retracted papers such as those by Duesberg and Ruggiero make my point.
    Seth Kalichman
    denyingaids.blogspot.com

  42. Dionysus said,

    September 15, 2009 at 3:17 am

    DavidN, I agree. I am a big of fan of Goldacre and his book but felt a little (really only a tiny bit) annoyed at the humanities bashing, precisely because it is so much more than post-modernism. I would agree that there is or has been an unhealthy trend towards post-modernist nonsense. But I would also argue that humanities contributes to valuable and useful knowledge. Humanities graduates can be historians, political scientists, journalists (good and bad), novelists and so on. Moreover, the humanities can be as nuanced and rich as science.
    A degree in physics won’t necessarily interfere with a critical understanding of Newton’s social role as warden of the Royal Mint, but it won’t necessarily help either. But of course, you don’t have to be a humanities graduate to be concerned about broader society, or critical of the Great Man version of history, either.

  43. widdowquinn said,

    September 15, 2009 at 10:30 am

    @Seth Kalichman

    From the Thomson JCR for 2008, the self-cites, and self-cites to years used in the impact factor calculation are:

    Medical Hypotheses: 9% (386/4109); 13% (164/1229)

    Journal of Theoretical Biology (used as a comparator by BGC in the Grauniad, for some reason): 6% (852/12876); 12% (241/1988)

    and, for further comparison:

    British Medical Journal: 2% (1981/68464); 5% (336/6606)
    Nature: 0% (4029/443967); 1% (1027/56676)
    Science: 0% (3454/409290); 1% (979/49771)
    PNAS: 2% (10195/416018); 3% (2415/63787)
    New England Journal of Medicine: 0% (2034/205750); 1% (520/32311)
    Journal of Bacteriology: 13% (7670/58715); 17% (1243/7253)
    Microbiology (SGM): 4% (444/9783); 5% (128/2168)

    J. Theor. Biol. and J. Bact. are perfectly fine journals, so I don’t see anything too unusual about the self-cite rate for Medical Hypotheses. I wonder if the proportion of self-cites is a poor indicator of quality, but rather inversely associated with the breadth of journal coverage and/or the corresponding size of the community?

  44. mikewhit said,

    September 15, 2009 at 1:49 pm

    Related to the subject of ‘humanities bashing’ is newspaper writers having any clue whatsoever about the subject on which they write.

    For example in today’s (15 Sep) Daily Express, an item on the E. coli farm outbreak refers throughout to the “E. Coli virus” … does that give you any confidence on anything else written there ?

  45. John Moore said,

    September 15, 2009 at 5:51 pm

    I’m one of the scientists who complained to Elsevier about the Duesberg and Ruggiero articles, and I feel absolutely no moral qualms about doing so. I have no sense that I am acting to “censor” alternative viewpoints. Far from it, for I acted in the best interests of the general public that funds most of the work that we scientists do. Scientists have a responsibility to protect, not harm the public, and yet the kind of material put forward in those two papers causes genuine harm to real people. Individuals die, or harm others, as a direct result of AIDS denialism, and of course over 300,000 South Africans died unnecessarily as a result of the government policies that Duesberg inspired. These are facts, not opinions.

    AIDS denialists thrive on the internet. They post their drivel on non-reviewed Blogs and web-sites. That’s the nature of the beast. But underpinning these postings is material that has appeared in professional journals, and listed on PubMed. Although most scientists (but sadly not all) know rubbish when they see it, that’s not the case with lay people. Members of the public all too often lack the knowledge to judge the merits of a paper, or indeed a journal, and they make the assumption that if a paper is in a PubMed-listed journal “it must be right”. The assume that AIDS denialism is based on publications of equal professional stature to the ones from real scientists that appear in “proper journals”. As noted above, the public doesn’t realize that the Med Hyp editor is the sole arbiter of the quality of what appears in that journal. The public deserves better than that. And scientists might fight to protect the public from such low standards.

    This latest scandal is not an isolated one. In the past, Med Hyp has published papers on the alleged and utterly spurious link between vaccines and autism. Those articles also damage the public, by again providing a sham veneer of “credibility” to the pseudoscience that lies behind the vaccine-autism link. And again, real people are harmed by such nonsense.

    It harms nobody if Med Hyp publishes papers on the Loch Ness Monster or the length of lines on palms. That’s all silly rubbish that makes the scientific and medical professions look foolish, but at least nobody dies as a result of reading it. But when it comes to AIDS denialism and the vaccine-autism allegations, lines are crossed because people ARE harmed. As scientists, we CANNOT live in Ivory Towers and natter away about our “rights” to publish anything and everything we want, whatever the consequences. Those rights are actually privileges, ones that are, in effect, granted to us by the public who fund what we do. We should respect that and act accordingly.

  46. Diddler said,

    September 15, 2009 at 6:24 pm

    Can I just add my voice to those of Dionysus and DavidN. I’m a huge fan of Ben’s work and his mission but the loaded remarks about humanities graduates is something that has repeatedly annoyed me both on this site and in the book.

    I presently have a strange double life as a humanties lecturer at an FE college and a scientific researcher, so I span both sides of the aisle.

    Science literacy and science education are two overlapping, but distinct things. Acceptance of scientific evidence and the scientific method don’t have to go hand in had with a career in it.
    The dismissal of all non-scientific subjects seems to be part of a strange one-upmanship mentality that implies osme sort of scientific hierachy we should all be subservient to. “I’m more scientific than you, my PhD trumps your MSc, I’m a physicist therefore ‘better’ than a psychologist”. The logical conclusion of which is that we should defer all cultural efforts to a handful of physicists with PhDs and that we in the sciences should all be very, very smug.

    The suggestion seems to be that A. All humanities graduates are scientifically illiterate B. All humanities graduates have been tainted by the horrible virus of postmodernism and therefore unable to understand what evidence is, and C. That there is never any real need for humanities graduates.

    I did an English degree in a strongly ‘postmodern’ department and my experience was very different to the stereotype you invoke. We were encouraged to be critical and reflective of the ideas presented. I honestly don’t know anyone ‘brainwashed’ by their undergraduate experiences, though plenty were challenged. Plenty of my fellow students called bullshit on it and wrote essays about how it was airy-fairy nonsense that lacked evidence. They still got high marks and were rewarded for their ability to think and write clearly. Postmodernism has had its time and has been dwindling in popularity in most academic departments since the end of Clinton’s presidency.

    Believe it or not, my ‘postmodern’ academic experience led me directly down the path to science, my MSc and then research. Had I not been exposed to those ideas I don’t think I would have found myself drawn towards empirical methods.
    Without my humanities degree I wouldn’t be able to do my job, nor would I have some of the richness in my cultural life. My degree taught me good ‘scientific’ virtues like independence of thought and critical thinking.

    Whisper it.. but there are plenty of rational, empirically-minded arts and humanities graduates out there. Quite a few of them are probably lurking on this site. Your choice of subject doesn’t automatically determine your attitudes towards science or evidence-based thinking.

    There’s an important and meaningful debate to be had about science education in this country. (For instance I agree some sort of compulsory science component in undergraduate degrees would do wonders for public levels of scientific literacy and I can only lament the Government’s failure to fully implement the findings the Tomlinson report) I just don’t think that scientific content is the sole value by which we can determine which subjects are with value and which are without.

    Anyway, grumble over.

    Ben, I’d love you to clarify your position on all this, clearly there’s a more than a few grumpy humanities graduates like me lurking on this site.

  47. TeeD said,

    September 15, 2009 at 7:30 pm

    ” clearly there’s a more than a few grumpy humanities graduates like me lurking on this site.”

    All seemingly unconcerned as to whether their comments are on topic or not.

    To get back to the subject of the post, there is a trail of misrepresentation associated with the Lancet treatment response paper. The first example I saw was Neville Hodgkinson, who wrote an article for The Business entitled “Anti-retro drugs fail to increase HIV patients’ lifespan”http://www.helpforhiv.com/antiretro.pdf

    Around the same time, Bookslut published an interview with Celia Farber, who offers the same misrepresentation in nauseatingly self-serving terms:

    www.bookslut.com/features/2006_09_009885.php

    “Of course [ACT UP and other activist groups] meant well! Of course they wanted to save their loved ones and brothers! Of course they didn’t know! But it was a disaster and we have to face it. The really weird thing about this whole thing is if you got on the phone with one of them, they would say people like me are responsible for mass deaths for planting the notion that HIV does not cause AIDS — which we discussed at the beginning — and for scaring people away from antiretrovirals. All I can say is only data speaks.

    [Farber begins to read from an Aug. 5 Lancet article, “HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis” (it looks at 20,000 patients in Europe and North America on cocktail therapy, also known as HAART therapy). “Virological response after starting HAART improved over calendar years, but such improvements has not translated into a decrease in mortality since 1996” (the year these drugs were launched).]

    AIDS is immune deficiency. AIDS is immune collapse. There are many roads that lead to Rome; there are many roads that lead to immune collapse. What we were saying about AZT in the early years is that, for god’s sake, this is a chemotherapeutic agent — an old cancer drug from the ’60s that was shelved as too toxic for human use. Chemotherapy obliterates the immune system. AIDS is a disease described as obliteration of the immune system caused by a virus. Protease inhibitors are a different kettle of fish. While they also greatly undermine the immune system they also weren’t total killers like AZT. They didn’t just mass destroy the cells; they brought some benefit as well. They’re broad-spectrum microbials. They did clear up infections and they absolutely did bring people back from the precipice of death. But what I just told you about is a ten-year perspective study. And when they looked over those ten years the utopian dream did not pan out. Their HIV levels are going down, whoop-dee-doo, but they are not living longer. It’s a very strange position to be in. Those of us on the skeptical side have never been more right but we have never been more hated.”

    Farber then later repeats the misrepresentation in an article for a magazine called Alive:

    www.alive.com/6146a15a2.php?subject_bread_cramb=328

    “After a period of intense marketing of antiretrovirals (drugs that purport to attack the HIV retrovirus), the drugs are no longer universally seen as lifesaving. A paper published in 2006 in The Lancet reported the results of a large study that tracked 22,000 HIV-positive people between 1995 and 2003. It found that the drug therapy they received, known as HAART (highly active antiretroviral therapy) did not “translate into a decrease in mortality.””

    Peter Duesberg has the paper on his website under the heading “Articles Documenting HIV is Passenger Virus”

    www.duesberg.com/articles/index.html
    www.duesberg.com/articles/2006,%20Lancet,%20HIV%20treatment%20resp..pdf

    But he doesn’t include the supplemental table from the paper with 2 year follow up, perhaps because that table shows that the number of AIDS events plummets in the second year of antiretroviral therapy (in flat contradiction to Duesberg’s claim that the drugs somehow cause AIDS).

    When Christine Maggiore launched an “updated” version of her book “What If Everything You Knew About AIDS Was Wrong?” shortly before she died she included the same misrepresentation:

    www.aliveandwell.org/cgi-bin/show_news.cgi?date=090107

    “The largest study of HAART (highly active antiretroviral therapy) contradicts popular claims that HAART extends life. Tracking 22,000 previously treatment-free HIV positives that began medications between 1995 and 2003, authors discovered, “Viral response improved but such improvement has not translated into a decrease in mortality.””

    If you google the quote “has not translated into a decrease in mortality.” you can find many more examples of people repeating the false claims of AIDS denialists regarding what the paper shows.

  48. DaveF said,

    September 15, 2009 at 8:58 pm

    @Diddler

    “there’s a more than a few grumpy humanities graduates like me lurking on this site.”

    Yeah I’m a pretty grumpy old humanities graduate who’s been lurking for three years and more, but haven’t dared say a word since the humanities-graduate bashing started — particularly after I seemed to have been subject to a humanities-graduate purge when I stopped getting Bad Science emails and I couldn’t get them reinstated.

  49. Ben Goldacre said,

    September 15, 2009 at 9:56 pm

    hi, i don’t think there’s any ambiguity here, i’ve never said i think all humanities graduates are morons. i have been very clear that the problem is humanities graduates who annoint themselves as experts and hold forth on a field without first stopping to familiarise themselves with the basics.

    if there is anywhere where i have said i dont like humanities graduates, rather than humanities graduates who grandly profess expertise in areas they demonstrably haven’t bothered to get familiar with, then do please let me know, so that i can correct it. but i don’t think i’ve said anywhere that i just don’t like humanities graduates.

  50. DrJG said,

    September 15, 2009 at 11:26 pm

    @ Bruce Charlton:

    I can see the arguments for maintaining an alternative to the peer-reviewed journal model as you state is your desire. There is a danger of the development of a scientific orthodoxy with no place for the dissenting view even if it has good supporting evidence.
    But, if you wish to take this path, you have a responsibility to ensure that that dissenting view is well-reasoned and presented. In publishing a paper which seriously distorts other important articles on the subject, you bring problems on your own head.
    You state that the paper in question was accepted according to the criteria for evaluation used by Medical Hypotheses. I can only conclude from this that those criteria do not include a need for claims made about the existing body of knowledge to be accurate. If so, then I think that you can hardly complain if moves are made to remove your journal from citation indexes.
    You appear to regard yourself as the guardian of something precious: If so, I can only suggest that you are taking poor care of it.
    Oh, yes, and the fact that Karl Popper was once on the editorial board cuts little ice with me when he died several years before you took over editorial duties.

  51. TeeD said,

    September 16, 2009 at 3:29 pm

    In the comments on The Guardian version of this post (which unfortunately are now closed), the current president of AIDS denialist organization “rethinking AIDS,” David Crowe, has posted two selections of quotes critiquing of peer review, with no commentary. Without a trace of irony, he quotes extensively from this Duesberg paper:

    Duesberg P et al. The chemical bases of the various AIDS epidemics: recreational drugs, anti-viral chemotherapy and malnutrition. J Biosci. 2003 Jun; 28(4): 383–412.

    e.g. “Even the professional journals and the science writers of the public media comply with the interests of government- funded majorities because they depend on their monthly scientific breakthroughs, the lucrative advertisements from their companies, and the opinion of their subscribers.”

    The paper also complains about how other journals refused to publish it. But this paper actually goes one better than the Medical Hypotheses paper and doesn’t just misrepresent a study on the benefits of antiretroviral therapy, it flat-out misquotes it.

    The authors – Peter Duesberg, Claus Koehnlein & David Rasnick – change a sentence from this paper:

    Declining Morbidity and Mortality among Patients with Advanced Human Immunodeficiency Virus Infection
    content.nejm.org/cgi/content/full/338/13/853

    that reads: “Patients with a diagnosis of cytomegalovirus retinitis or M. avium complex disease before study entry or during the first 30 days of follow-up and patients with active P. carinii pneumonia at the beginning of follow-up were excluded from the analyses of the incidence of that opportunistic infection.”

    To: “Patients with a diagnosis of cytomegalovirus retinitis or M. aviarum complex disease before study entry or during the first 30 days of follow-up and patients with active P. carinii pneumonia at the beginning of follow-up were excluded.”
    www.virusmyth.com/aids/hiv/pddrchemical.pdf – page 399

    In order to pretend that the people with AIDS described in the Palella paper weren’t sick before starting antiretroviral therapy, because Duesberg’s theory says antiretrovirals cause AIDS. The paper actually shows that mortality was highest in people who received no treatment, and lowest in people on combinations including a protease inhibitor.

  52. Lloyd said,

    September 16, 2009 at 8:23 pm

    Dr Goldacre may find that he is in a difficult position. He has used terms such as “almost surreally crass” and “a new domain of foolishness” to ridicule Bruce Charlton’s journal, and having done so will now risk making himself look rather foolish if he publishes a retraction. I respect the notion of a website that illuminates cases of bad science in the media. However there is a danger that the single voice of Dr Goldacre becomes too powerful, and I certainly do not see it as his place to decide what can or cannot be said. Medical Hypotheses is not a typical science journal, but makes no claim to be. One of the worst things about bad science is when something that is bad science, or even not science, puts itself across as good science, and is therefore given credence it does not deserve. Medical Hypotheses does not pretend to be something that it is not. Neither is it widely read by
    the lay public. It is intended as a means of stimulating new ideas, and perhaps enabling scientists to go a bit further off the beaten track than they are normally allowed to go. If articles in MH are taken out of context by other media writers, and given greater weight
    that they deserve, then this is a mistake of the lazy journalists who do this.

    Ben Goldacre does not have the right to decide what is and what isn’t acceptable to theorise. If ever he has the effect of stagnating debate and restricting new ideas, then he has become the enemy of science. He may write what he wishes, but should not encourage a campaign to shut down a journal. Science is not an opinion, nor a
    consensus. When a journalist writes “scientists believe” he is usually being lazy and misleading. Science is simply a method for finding things out. One of the things required for good science to thrive is a world in which people can come up with new ideas and try
    them out. At any given moment, the scientific mainstream is in a particular state. The only way this can change is if people are allowed to spread new ideas. Without new unaccepted ideas, science halts. If an idea is published in a journal, and that same journal publishes several other ideas that are bad, then the first idea is
    scientifically no worse by association with those other bad ones. An idea is either good or not good, and the person who came up with it is an irrelevance, as is its proximity in a journal to other ideas.

    Dr Goldacre runs a website which in some ways resembles MH. He is its one editor. He writes what he pleases to write. I agree with much of what he writes. I disagree with much of what he writes. It would not occur to me to mount a campaign to ban his site because I disagreed with one of the items on it. I do not see in Dr Goldacre’s writing any plainly-expressed call for an end to MH, but he is now a man of influence, and may even spark a witch-hunt when he did not mean to. If Dr Goldacre finds a bad idea in MH, he should attack the idea because it is bad. Peer review is flawed, as he admits in his article. If everything has to be peer reviewed to be accepted as “science” then one of the main flaws of peer review (that ideas not in keeping with the current fashion become suppressed) becomes massively magnified. A partial remedy for this is to have outlets that are not
    peer-reviewed for new scientific ideas. So long as those outlets are clearly labelled as what they are, this is fine.

  53. John Moore said,

    September 16, 2009 at 9:53 pm

    I cannot agree with Lloyd, particular over the comment “Medical Hypotheses does not pretend to be something that it is not. Neither is it widely read by the lay public” These statements might be true from a purely technical perspective, but they miss an important point that I wrote about in post 45 yesterday. Apologies for any repetition of the same theme here, but it seems that at some people at least have rather missed the point.

    The AIDS denialist groups desperately seek to get their pseudoscience and anti-science views into any journal whatsoever that has some form of credibility, and being listed on PubMed does provide a journal with perceptional credibility. The lay public indeed rarely reads the journals, and members of the public probably don’t have the general knowledge to tell the difference between Med Hyp and Nature or the NEJM. The AIDS denialists ruthlessly exploit that lack of knowledge. They do so by posting “their” papers on websites, and by referring to them as examples of how “their” work has passed peer review (sic), so MUST be quality science. They do this to confuse the public, and the tactic works, at least to an extent. Readers of the denialist web sites who lack a scientific background cannot and do not discriminate between what’s in the denialist papers, and what’s in the vast body of scientific literature on HIV/AIDS. Med Hyp itself might well not “pretend to be something that it is not”, but for sure the AIDS denialists pretend that it’s a quality, peer-reviewed journal. And by doing so they fool, and harm, the lay public.

    I don’t follow the vaccine-autism websites, but I think the same scenario likely applies there: “If it’s in Med Hyp, it must be right, right?”.

    The way to stop these abuses of the scientific literature is to ensure that only sound, solid science with a rational basis is published in peer-reviewed, PubMed-listed journals. There are websites dedicated to the advancement of crazy ideas that are contrary to the best interests of public health. Their existence is a great shame, but there’s nothing that scientists can do about that. What we can do is insist on high standards for the scientific literature. Med Hyp has not met those standards, and in not doing so it has betrayed our profession.

  54. DavidN said,

    September 17, 2009 at 11:37 am

    Point taken.

    I was shocked last year to hear of AIDS denialist tropes being passed around a dinner table with a very well known British-American businesswoman last year, herself well acquainted with scientific knowledge and her husband being a major educational benefactor.

    I think for some people they have multiple and conflicting worldviews and it only seems to bother me/us. Even bringing up peer review makes people yawn. Anti-science thinking has encroached in many other ways, sbversively ‘management’ theory is one that prports to be scientific in a way bt is certainly not.

    Most people that earn a decent wage and live in the nice areas of this city, seem to have a major affectation for alternative medicine. So many doctors are no utilising ‘integrative’ many more than when I left a few years ago.

    I’m tired and rambling and am going to get flamed for this probably.

  55. TeeD said,

    September 17, 2009 at 5:30 pm

    “I’m tired and rambling and am going to get flamed for this probably.”

    Not by me, I felt bad for taking a dig at disgruntled humanities grads before and I think you make a good point about the encroachment of anti-science thinking. I just noticed that the latest attempt at propaganda for AIDS denial, a seemingly well-funded “documentary” entitled House of Numbers, lists as an Executive Producer Martin Penny, who I think is also a major educational benefactor in the UK (he’s CEO of Good Hair Day). Penny is also cited as supporting an upcoming AIDS denial conference in the US in November:

    ra2009.org/index.php?option=com_content&view=article&id=52&Itemid=57

    According to the internet archive, Penny’s name was added to the list of people “who doubt the HIV-AIDS theory” between June 29 and July 2 of 2007:

    web.archive.org/web/20070629184931/http://www.rethinkingaids.com/quotes/rethinkers.htm
    web.archive.org/web/20070702055910/http://www.rethinkingaids.com/quotes/rethinkers.htm

    Bizarre.

  56. Nasimf said,

    September 17, 2009 at 7:10 pm

    My 2p worth. I don’t think we want censorship.

    Peer review has its pitfalls (particularly in the exposure of most scientific fraud, where journals do a piss-poor job except in headline cases). That is not to say that MH does a good job, or serves a wortyhwhile purpose, but it could do.

    After all they publish anything written in (reasonably comprehensible) English and it would seem an ideal forum for a robust response.

    I would personally favour the existence of many more journals like MH, but with some gatekeeping (over factual content as opposed to interpretation).

    Journals have totally useless correspondence sections, which is a problem.

  57. DavidN said,

    September 17, 2009 at 8:26 pm

    @TeeD I find Aids denialism extremely disturbing.

    When Jeanette Winterson advocates Homeopathic remedies for AIDS in Africa etc it is tantamount to saying “These people do not deserve real tested treatment for their illness”. That’s only a few steps from ideas advocated by American Celebs that one’s life is wholly predicated on their thought patterns.

    I am going to have a good read of this (probably while sitting through this boring conference I’m being sent to today).

    I think AIDS denialism is illegal in NZ where I live at the moment. There was a major campaign about the science of AIDS after a young girl Eve van Grafhorst died in the 90’s. I should check it out.

  58. jtuomist said,

    September 18, 2009 at 2:21 pm

    If we think of a typical article, it consists of two parts: first, a description of the study design and the data obtained; second, interpretations of the results and discussion in a wider context. The first part is permanent in time, as the observed data does not change. In contrast, making interpretations is a social activity (involving also other researchers than the original authors), and it will change in time (sometimes dramatically).

    Only the first part should be archived in a frozen, article-type form. These could well be published first and peer reviewed only later, as is the current practice in some fields of science (see arxiv.org/).

    The second part, interpretations, should be dealt with in open workspaces designed for mass collaboration. There are methods to effectively organise these discussions to achieve convergence. To give one example, see pragma-dialectics in Wikipedia. These methods are still under-utilised (this blog is a typical example).

    As an example, let’s look at the current discussion raised by Peter Duesberg and David Rasnick. If their interpretations are on shaky grounds, they could have easily been shot down in an open workspace, without any need of editorial decisions. In an open workspace, anyone could publish their statements (idea promoted by Bruce G Charlton) and all statements incoherent with facts would be invalidated (idea promoted by Ben Goldacre) by peers. There is no need to remove invalid statements, because they are shown to be invalid. On the contrary, it prevents from repeating invalid statements.

    A paradigm shift to open scientific workspaces has at least two major problems. It is not clear how scientists could get merit from participating in mass collaboration instead of writing articles. In addition, this might cause problems to the business logic of scientific journals.

    We have drafted a procedure description for a journal that is based on the ideas briefly described above: Opasnet Journal (en.opasnet.org/w/Opasnet_Journal).

    Mikko Pohjola
    Jouni Tuomisto
    environmental health scientists
    THL, Finland

  59. heavens said,

    September 22, 2009 at 12:28 am

    I have a question for Bruce Charlton:

    Is there any particular reason that you couldn’t add the fairly basic level of fact-checking that a daily newspaper does to MedHyp? That is, if you see some _fact_ being wildly misrepresented, you call the author and say, “There seems to be an error here, and I hope you can fix it and re-sumbit,” instead of saying “Eh, it’s wrong, but who cares what lies are in it, as long as I sell papers?”

    I’ve gotten simple facts wrong before (e.g., by overlooking a single word in a paragraph), and I’ve always appreciated people pointing it out to me. Surely this would be better than having the entire world ridicule the author, the journal, and yourself.

  60. heavens said,

    September 22, 2009 at 12:31 am

    Also, to other readers:

    I don’t think that MedHyp’s dubious reputation is known outside of the medical scholars. I remember a well-respected and very senior chemistry professor at a large American research university gloating about a graduate student publishing something in this journal. He thought that the quick response and lack of changes meant that the idea was absolutely perfect and predicted great things for the student’s career.

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