A royal mess

July 1st, 2004 by Ben Goldacre in alternative medicine, bad science, dangers, death, herbal remedies, nutritionists, PhDs, doctors, and qualifications, references, statistics | 5 Comments »

Ben Goldacre
Thursday July 1, 2004
The Guardian

· I always thought the monarchy was there to remind us that inherited wealth and privilege are alive and well, and to stop us falling into the American trap of imagining that we live in a meritocracy: but apparently it’s there to set the health research agenda. Prince Charles is keen that we should not ignore the experience of the one person he met who got better with the Gerson nutritional regime for treating cancer. Let’s ignore the fact that the American Cancer Society regard it as dangerous; that in two years San Diego county hospitals treated 13 patients with campylobacter sepsis from the Gerson clinic, probably due to the raw calves’ liver injections; that several patients have been admitted comatose with low sodium levels; and that caffeine enemas are jolly dangerous and have been associated with severe colitis, infections and death. No. Let’s focus on the research already done on Gerson. One long-term study of 21 patients (by a naturopath, no less) found that only one was alive five years after treatment. In 1986, researchers found that despite their claims, some patients from the Gerson clinic were not even followed up. There are papers claiming efficacy for nutritional therapy that find a positive effect, but without bothering to give us the figures. Since then, a handful of studies have been done, suggesting a minor positive effect, but the flaws in their methodologies render them worthless.

· Let’s get this straight: research is not difficult, and it doesn’t need a lot of money. Lots of medical research is done by junior doctors, in their “spare time”. Alternative therapists are welcome to research money, but it would be nice if some of the money they get could go towards keeping follow-up records, which doesn’t cost much, and even do some proper statistics. So if you’re a quack and you’re angry about the lack of evidence supporting your ideas, here are some fun ideas for the holidays. Buy How to Read a Paper: The Basics of Evidence-Based Medicine by Trisha Greenhalgh (BMJ Books), an excellent introduction to how research works. It’s even available free online. Make friends with someone in a university or hospital, and you can use their audit department or statistics advisory service to help you design the study, often for free. But please, at least put the figures in your paper. And register your studies on the national database, so we can have a good laugh when you turn up negative findings.

Artificial intransigence

June 24th, 2004 by Ben Goldacre in bad science, bbc, dangers, nanniebots, new scientist | 2 Comments »

Ben Goldacre
Thursday June 24, 2004
The Guardian

· You may remember Jim Wightman. He claimed to have written a piece of chat software that could pass itself off as a real child in a chatroom, and identify internet paedophiles by behaviour. To say this was thought highly dubious is an understatement – the software, if it existed, would have been 10 years ahead of everything written by huge teams of AI academics; he offered to let us see the software working, and then refused; and the NSPCC and Barnardo’s distanced themselves from his ideas about monitoring children’s activities himself with no child protection background. Embarrassingly, New Scientist accepted his claims uncritically, and the BBC and others followed suit, although New Scientist did, after two pieces here, remove their glowing article about him from their website.

· Now they’re back with Wightman. Here’s what happened. New Scientist visited Jim at home with two AI academics to chat with the program. In previous “test conversations”, over the web, without experimenters being able to see that the computer was not connected to any others, the program gave highly sophisticated answers after a suspiciously long delay (almost as if someone was typing them). This time it instantly gave rubbish computer-generated responses, nothing like those in the previous transcripts. In fact, it gave the very same answers that Alice, an old and not very sophisticated AI program, written by somebody else, not Wightman, gave in subsequent tests. Then Wightman offered to show them the code … but suddenly, and inexplicably, the power to Jim’s whole house went off. The test was over. Imagine.

· Did New Scientist finally give it up? No. “New Scientist can still provide no definitive proof of Wightman’s claims, but looks forward to a return visit when the complete ChatNannies software is available for testing.” Please. Did they ask Wightman about his unlikely claim to have a seven-figure offer from an American corporation which had “full independent testing performed on the AI and are confident of its validity and effecacy[sic]”? He was apparently quite capable of giving them a proper demonstration. Did they quiz Wightman on his previous false claims about writing software, or any of the other issues Bad Science raised? No. To those of us brought up loving the great institution that is New Scientist it is, as Tibor Fischer said, a bit like bouncing out of the classroom at breaktime, only to catch your favourite uncle masturbating in the school playground.

Get yourself a proper science education

June 17th, 2004 by Ben Goldacre in bad science, dangers, very basic science | 1 Comment »

Ben Goldacre
Thursday June 17, 2004
The Guardian

· It’s hard to know who to trust in these dark days. Although an article in Physics Today by Dr John Hubisz suggests that US school science textbooks might not be your best bet (www.tinyurl.com/2l3dk). Ever heard the 50Hz low bass mains hum coming through your crappy stereo? Me too. So you’ll be surprised to hear that elephant vocal sounds occur at 400Hz, and so can’t be heard by humans. Middle A is at 440Hz after all, and there are about 40 notes on the piano below that. Pictures of prisms bending light the wrong way; Van de Graaff generators that store charge in their base; lamps that supply voltage; and absolute zero defined as the temperature at which molecules are so cold they don’t move. It’s enough to drive you to the humanities.

· Not strictly bad science but, as reader Catherine Moulton points out: if you really want to get kids experimenting with science for themselves, you could try www.geekdiy.com. Allow me to illustrate the depths of my childish irresponsibility. Capacitors are the big round things you see on circuit boards when you pull electronic stuff apart. They store the potential energy of accumulated electrons in the form of an electric field, across two metal plates. That’s how the little batteries in disposable cameras can build up enough energy to set off a big flash from the bulb on the front. The page on geekdiy is down now, but frankly, if that isn’t enough information for you to construct your own stun gun for £8.99 then you don’t deserve one. Suffice to say, when the oil runs out in 30 years and modern civilisation is annihilated in a hideous nuclear war, and we’re all fighting each other tooth and nail for tins of genetically modified baked beans … I don’t rate the chances of the humanities graduates much.

· Meanwhile, on geekdiy.com you can still find all kinds of useful tricks to help you reconstruct a post-enlightenment society after the holocaust, including a powerful high-quality Dobsonian telescope from an old record player and some household bits and pieces; a full-sized remote controlled car for those hit and run shopping trips; an android head to guard your booty; and a mountainside covered with fake snow, so you don’t have to miss out on those snowboarding holidays just because the aeroplanes are all being lived in by extras from Mad Max. Get yourself a proper scientific education: it’s later than you think.

Wort warning

May 20th, 2004 by Ben Goldacre in bad science, dangers, herbal remedies | 2 Comments »

Wort warning

Ben Goldacre
Thursday May 20, 2004
The Guardian

Talk about bad science here

· People often ask why I get so grumpy about the lack of intellectual rigour in alternative medicine. “What’s so bad,” they say, “about people believing whatever they want, if it makes them feel better?” What’s so bad is that sometimes, when people mix and match ideas, and believe that “natural” means “safe”, they can concoct some pretty dangerous suggestions.

Over to Richard Brook, chief executive of mental health charity Mind. “Prozac or cognitive behavioural therapy?” the Independent asked him last week. “CBT every time,” he replied, and fair enough. “I’m a strong supporter of non-medicated approaches, which also include exercise, improving social contacts, diet” he said. Excellent advice so far. “And possibly homeopathic remedies such as St John’s Wort.”

Now, homeopathic remedies are pretty close to pure water, and that’s not going to do you any good or any harm. But St John’s Wort contains a drug that is very similar to Prozac, which can interact dangerously with many antidepressants and numerous other medications. And unfortunately, as they say, not a lot of people know that. Researchers at King’s College London questioned 929 people, visiting four pharmacies in London, and found that when they asked people which medicines they were taking, 41% did not mention herbal remedies, because they did not think of them as medicines. Seven per cent were taking potentially dangerous combinations of herbal remedies and prescription medicines, and the most common was taking St John’s Wort at the same time as SSRIs, the class of antidepressants that includes Prozac. What’s more, taking St John’s Wort with the oral contraceptive pill can cause side effects and stop the pill working. Even pharmacists can believe the hype. In 21 visits to buy St John’s Wort, five Which? researchers were given unsatisfactory advice, twice they didn’t need to see a pharmacist, and one pharmacist said it was “fine to take with the pill”.

· About a quarter of prescription drugs are derived from plant sources and just because something comes from a plant doesn’t mean it’s safe. Aspirin comes from willow bark, but it will still make your haemorrhoids bleed. Diamorphine was made from opium poppy extract, in the same lab as aspirin, by the same bloke, two weeks later, using the same process (acetylation), 107 years ago this summer, since you ask. Diamorphine is also known as heroin, and although it’s undoubtedly effective, it has a few side effects that might worry you.

This slightly odd letter was printed the following week.

Wort warning

May 20th, 2004 by Ben Goldacre in alternative medicine, bad science, dangers, herbal remedies, homeopathy | 2 Comments »

Ben Goldacre
Thursday May 20, 2004
The Guardian

· People often ask why I get so grumpy about the lack of intellectual rigour in alternative medicine. “What’s so bad,” they say, “about people believing whatever they want, if it makes them feel better?” What’s so bad is that sometimes, when people mix and match ideas, and believe that “natural” means “safe”, they can concoct some pretty dangerous suggestions.

Over to Richard Brook, chief executive of mental health charity Mind. “Prozac or cognitive behavioural therapy?” the Independent asked him last week. “CBT every time,” he replied, and fair enough. “I’m a strong supporter of non-medicated approaches, which also include exercise, improving social contacts, diet” he said. Excellent advice so far. “And possibly homeopathic remedies such as St John’s Wort.”

Now, homeopathic remedies are pretty close to pure water, and that’s not going to do you any good or any harm. But St John’s Wort contains a drug that is very similar to Prozac, which can interact dangerously with many antidepressants and numerous other medications. And unfortunately, as they say, not a lot of people know that. Researchers at King’s College London questioned 929 people, visiting four pharmacies in London, and found that when they asked people which medicines they were taking, 41% did not mention herbal remedies, because they did not think of them as medicines. Seven per cent were taking potentially dangerous combinations of herbal remedies and prescription medicines, and the most common was taking St John’s Wort at the same time as SSRIs, the class of antidepressants that includes Prozac. What’s more, taking St John’s Wort with the oral contraceptive pill can cause side effects and stop the pill working. Even pharmacists can believe the hype. In 21 visits to buy St John’s Wort, five Which? researchers were given unsatisfactory advice, twice they didn’t need to see a pharmacist, and one pharmacist said it was “fine to take with the pill”.

· About a quarter of prescription drugs are derived from plant sources and just because something comes from a plant doesn’t mean it’s safe. Aspirin comes from willow bark, but it will still make your haemorrhoids bleed. Diamorphine was made from opium poppy extract, in the same lab as aspirin, by the same bloke, two weeks later, using the same process (acetylation), 107 years ago this summer, since you ask. Diamorphine is also known as heroin, and although it’s undoubtedly effective, it has a few side effects that might worry you.

Our very own health scare

September 11th, 2003 by Ben Goldacre in bad science, dangers, detox, nutritionists, scare stories | 3 Comments »

Ben Goldacre
Thursday September 11, 2003
The Guardian

· Monday’s Daily Express gave details of an exciting treatment called “thalassotherapy”. Basically you sit in a bath of salt water, seaweed, algae and mud, and then… “because the seawater is at body temperature, mineral ions pass into the blood and encourage toxins to pass out,” says the paper. This is terrifying information. I’d always been quietly pleased with my skin, it being relatively impermeable since my ancestors moved out of the sea. But apparently not, and the implications are terrifying: does this mean all that time I’ve spent in the bath, things have been leaching out of me into the bath water? Or have I been sucking water in? No wonder I’m so big and puffy.

· But apparently it’s more than just ions: “All the vitamins, minerals and trace elements are at exactly the same level and [sic] concentration as they are in your body… by a process of osmosis, your body will take in any nutrients it needs from the seawater. It’s a highly effective treatment,” says Dr Christian Jost, “a consultant in thalassotherapy, from Inchydoney Island Lodge and Spa Thalassotherapy Centre in West Cork, in Eire”. So if you want to lose weight without the Atkins, why not sit in a bath of pure water, and let the “nutrients” just seep out of you? Or help yourself to that extra serving of pasta, and then go for a walk in the rain to gently wash it all away?

· And as for the paper’s claim that “joint mobility and range of movement are 10 times easier in sea water?” I hold my head in my hands and wonder: what can that possibly, possibly mean?

· These tabloids are getting so lame at starting health scares, I’m thinking about seeding a few of my own. The Daily Mail can’t even manage to backtrack on its previous adulation of the Atkins diet without making claims like high fat diets double your risk of breast cancer, an assertion for which the data is famously conflicting. But I’m hunting bigger game. So here goes: one traditional Chinese herbal medicine has just been reported as having 11 sudden deaths attributed to it in just two years. But I’m not going to tell you which one. Until next week. Or maybe never. After all, with the stampede that doctors have to endure with every new health scare, I quite like the idea of a nation of hypochondriacs from the “natural means safe” school beating a path to the door of their local snake-oil salesperson to find out…

Cures for quacks

June 19th, 2003 by Ben Goldacre in alternative medicine, bad science, dangers, herbal remedies, water | 8 Comments »

Ben Goldacre
Thursday June 19, 2003
The Guardian

· The plural of anecdote is not data. Although it’s always very tempting. So although I’ll contain my evil desires to titillate you with tales of patients who’ve needed liver transplants after taking Chinese herbal remedies, I’m very amused by an article in the Lancet about a Chinese remedy company who seem to be putting artificial drugs in their potions. Spes capsules were examined by physicians treating a patient who developed Cushing’s Syndrome and were found to contain betamethasone, a potent synthetic glucocorticoid you wouldn’t expect to find in any magic herb. They also found alprazolam, a synthetic benzodiazepine much like the addictive “mother’s little helpers” of the 60s, which might go some way to explain the improvement in “quality of life” claimed for Spes. Neither was mentioned on the label. Alternative therapy fans might bear in mind that, if a herbal remedy works it’s probably got something potent in it.

· A BMJ paper recently found that children being treated with Chinese herbal skin creams for eczema were on average receiving five times the recommended adult dose of dexamethasone, a potent steroid. Which makes it very amusing that the alternative medicine lobby has ganged up against an EU directive to use proper ingredients labels and submit to regulation, like anyone else peddling a medicine. They say it’s part of a campaign by the medical establishment to discredit their products, and 5,000 people marched against the regulations in London last Sunday. They had Tory MP John Redwood lambasting the EU for over-regulating us. But even the Daily Mail, champion of anecdotal evidence, favourably reported a study of 200,000 people that showed a 0.4% increase in deaths from all causes in people taking beta-carotene supplements, and no benefit at all from vitamin E.

· 200,000 people seems to be enough for a study disproving alternative therapies to be taken seriously. If you’re in the business of promoting pseudoscience, standards seem to be less stringent. Last weekend’s Sunday Telegraph devoted the whole of page 3 to alternative therapy porn, with a story on how drinking the Queen’s Royal Deeside spring water improved arthritis symptoms in two-thirds of patients. It was a study of 34 patients over three months and there was no control group. It’s hard to imagine an experiment where it would have been easier to come up with a convincing placebo. Water.