Sunday 29 November 2009

A test of your stamina for nerdiness/BS tolerance

A very brief introduction to homeopathy for those who aren't familiar with it:

Homeopathy is a unique form of so-called 'alternative' (sadly in most cases, for this read: 'not evidence-based') medicine established by a German doctor, Samuel Hahnemann, in the 1790s. It is based on the following principles:
  • 'Like cures like' - substances that are similar to a disease- or other biological state-causing agents are most likely to provide a cure. So for example, insomnia might be treated with caffeine.
  • The smaller the concentration of the active ingredient, usually in pill or liquid form, the more powerful its potency. Homeopathic convention states that the most powerful treatments are those that have been diluted to such an extent that they contain just one, or even no remaining molecules of the original substance.
  • The above theory is based on the idea that water has a 'memory' - so therefore its the dilution process itself, rather than solely the inclusion of a substance, that is argued to have therapeutic effect.
Contrary to what many people think, homeopathy is therefore not a herbal or 'naturopathic' medicine, which contain active ingredients at a potency with physiological and potentially clinical effect.

Even without clinical trials, the theory supporting homeopathy is fatally and actually very obviously flawed. Any glass of water, or breath of air, or anything else that I ingest is likely to have once contained all manner of substances, including those that are toxic or thoroughly unpleasant at sufficient doses. Think of where your toilet water goes and where your tap water comes from...so its really implausible to suppose that water can somehow distinguish between the ingredient in question and all the other substances its molecules have ever come into contact with.

If this were true, all our basic scientific understanding of toxicity and principles of medicine, not to mention the laws of physics, would be critically challenged and face urgent re-examination. But the evidence just doesn't support that this is the case. If we accept this kind of reality-bending theory, then there is no distinction between medicine based on evidence and that based on magic, fraud or nonsense.

The weight of scientific evidence falls heavily against the clinical effectiveness of homeopathy. Although some trials might show a positive effect, generally speaking these are of poorer quality than those that show no effect of homeopathic medicines beyond the placebo effect. Homeopaths have a tendency to selectively cite studies that show support, without considering the evidence in its totality. One can only assume that this demonstrates either a very poor calibre of science, or intentional deception.

The problem is that many people, including intelligent, discerning types, cite personal experience of the benefit of homeopathic remedies, and nobody would wish to insult their testimonies, especially those from the desperately ill. However, to deny that their recovery is likely to be due to homeopathic remedies is not to call them stupid or deluded but to give appropriate acknowledgment to the power of placebo and the limits of anecdotal evidence. This has (like everything) been covered extensively by Ben Goldacre, so I won't go into it in any detail here. The placebo effect and the unreliability of personal experience affect us all, often at a level below what we can consciously access, and so it is not something that should be mocked.

Anyway, bearing all this in mind (you'll really need to look into homeopathy further to get a full picture, I haven't covered the purported and often flawed evidential support for it, or its bizarre, ritualistic processes in sufficient detail, but a little Googling should go a long way. Also see the NHS site for a comprehensive overview and introduction to evidence-based medicine), you'd imagine that it would be a fringe practice, generally ignored by and excluded from conventional medicinal authorities...but sadly this isn't the case...

Homeopathy is available on the NHS. There are several NHS homeopathic hospitals and some GP practices offer homeopathic remedies. The Medicines and Healthcare products Regulatory Agency (MHRA), an executive agency of the Department of Health, who according to their own site "enhance and safeguard the health of the public by ensuring that medicines and medical devices work and are acceptably safe [...] Underpinning all our work lie robust and fact-based judgements to ensure that the benefits to patients and the public justify the risks", has allowed homeopathic pills to make medicinal claims.

This decision by the MHRA was recently reviewed by the parliamentary Science and Technology Select Committee, in a pleasantly surprising example of real policy evaluation, attended by an impressive cast including the big BG himself. You can watch it online here. This needs no further comments and should really be watched by anybody interested in the relationship between medicine and policy.

(Highlights are available for those that can't tolerate this level of nerdery and shocking BS spewing by certain contributors here)

Sexy Sunday Science

What I love the most about scientific study of human sex is the decidedly non-sexy language researchers tend to use: 'coitus', 'copulatory vocalisations', 'female orgasmic capacity' and the like. Mmm.

Ok, I know that the alternative would perhaps be even sillier and that this is not relevant to the validity of such studies but juvenile that I am, I couldn't help mentioning it.

So anyway, here are a couple of nice...tit bits...from recent research, presented at the International Society for Human Ethology Conference, Maine in July 2009:

The ease of orgasm from heterosexual penetrative sex in women is positively correlated with the ratio of first finger to third finger length - that is, the more that your third finger is longer than your first, the greater your 'coital orgasmic ability' (Lara Eschler, Cambridge University. I can't seem to find this as a published study, but she's a PhD student so I assume the data comes from her ongoing work).

Female orgasm during heterosexual vaginal intercourse is not correlated with the intensity of orgasmic vocalisation. Though greatest reported frequency of orgasm occurred during non-intercourse sexual activity, the greatest intensity of vocalisation occurred immediately prior to or during male orgasm (Brewer, Morgan and Hendrie - 'On the adaptive significance of female copulatory vocalisations', from the University of Central Lancashire and the University of Leeds - again as yet unpublished as far as I can tell).

Sunday 22 November 2009

The ever lurking antioxidants

Is anyone else concerned that the scientific standards of the prestigious journal 'The Metro' might be slipping? I noticed an advert the other day for Sambucol, a product claimed to help "support the immune system" that has been "tested in published clinical studies", and that can help prevent catching "winter's bugs". References are made throughout the ad to coughs and sneezes, suggesting its being touted as a cold and flu medicine. It is made from elderberry extract, raspberry extract, citric acid and potassium sorbate (a preservative). It's claimed that the product's apparent medicinal properties are due to the high antioxdiant content of elderberries.

Hmm.

Evidence for the medicinal properties of antioxidants is mixed at the very best. Although early evidence from the 1980s seemed to suggest that antioxidants were implicated in reducing susceptibility to cancer, since then the literature has generally failed to support the use of antioxidant supplements to improve health. This 2008 review by the Cochrane library - an impartial research organisation that looks at all available (and of reasonable quality) published studies for a particular treatment and draws conclusions about efficacy and safety - found no evidence that antioxidant supplements treat disease or prolong life, from 67 randomised trials with 232,550 participants in total. In fact, it was found that antioxidants vitamin A, vitamin E and beta-carotene actually were associated with increased mortality.

This of course is a very crude summary of complex and wide-ranging literature, so I'd recommend looking deeper for a more detailed analysis. However it can certainly be said that there is no strong body of scientific literature that supports medicinal properties of antioxidants.

These are powerful health claims, especially at a time when influenza (both the seasonal and H1N1 'Swine flu' strains) is a significant threat to health and there is a distinct wariness towards the H1N1 vaccine amongst many members of the general public. The phrase 'they haven't even tested it properly yet' has become disconcertingly ubiquitous. It is therefore pretty irresponsible to make such strong claims and for

"But we're not still evolving..."

A genetic mutation that protects humans from kuru - a disease passed on by eating infected brains - has been identified, and crucially, it is only two hundred years old.

Simon Mead, of the University College London's prion research centre, and colleagues examined DNA from the brains of Fore people from Papua New Guinea, where the ritual practice of eating human brains persisted until the 1950s. They compared those who had eaten brains and died to those who had done so and survived, and found in the latter group a hitherto gene variant which protects the bodies in which it resides from kuru. The researchers claim that it arose only two hundred years ago and therefore that it demonstrates modern natural selection in action.

This kind of research is an excellent rebuttal to creationist/anti-science rhetoricians, or simply an answer to innocent lay inquirers, who question the ability of genetic mutations to produce phenotypic effects beneficial to survival. The answer is simply that it does happen, even if less commonly than mutations that damage the body.

Kuru is a horrendous disease that turns brain tissue into non-functioning, spongy mush, much like BSE in cows and vCJD in humans, so not only is the research a fascinating reminder of the effect of natural selection on humans, but also hopefully a step forward in preventative understanding.

http://www.newscientist.com/article/dn18172-gene-change-in-cannibals-reveals-evolution-in-action.html

Mead, S. et al (2009) 'A novel protective prion protein variant that colocalizes with kuru exposure' New England Journal of Medicine, 2009, volume 351 p. 2056