Sunday Blasphemy » Prick-Eared

Growing up, my mother was very into sciences; however because she is largely illiterate, she often relies on anecdotes which lend itself to alternative methods such as the blood-type diet, naturopathy, chiropractic et cetera. At one point, she was anti-vaccine because I was one of the few who did not receive the benefit of the meningitis shot; and fell under a spell from the side-effects for a year. The statistical possibilities of the vaccine causing averse reaction is astronomically low, even perchance a reoccurrence is extraordinary unlikely. There is no reason whatsoever to reject the principle of immunology. To make the matters even more bizarre, when I slipped into situational depression for about four years after academically studying the folly of human nature, she suggested a host of treatments which made little sense: testosterone injections, B12 supplements, sunlight therapy, gluten-free diet, sugar pills; all of these were completely irrelevant because it wasn’t the chemistry that was off, but rather it was the refusal to help oneself. Thinking back, it is rather unfortunate she only has a 4^th grade education because she really is a brilliant woman who would had benefited from educating herself.

Of course, reasoning with my own mother was futile; which always inevitably leads to a nervous breakdown about how no one values her opinions. So, it was one of those things a child learned to put up with and seek mentorship elsewhere. Again, it is one of those scenarios of “well, if her parents valued school to achieve higher education [...] people won’t be so quick to discard the wisdom.”

Sadly, I see the same psuedo-sciences such as the raw diet, natural rearing, herbalism, aromatherapy et al occurring among my own peers. For a long time, it was puzzling to see why people buy into the New Age medicine until I started looking into how medical researches are conducted. No wonder why we have so many loony people today buying into stuff like homeopathy, the paleo diet and so on, the studies themselves don’t publish the full results or the potential biases. To make it even odder, when contested about the absence of data, many of the people who tout these scientific claims retorted “that’s what you believe!” Sorry, sweetie, relativism have no place when it comes to one’s health.

Recently, a contact sent me a lecture which accurately describes what is going on: Ben Goldacre touched on the distortion of science which gave rise to some really wacky claims on the Internet and among the peons.

Transcript

So I’m a doctor, but I kind of slipped sideways into research, and now I’m an epidemiologist. And nobody really knows what epidemiology is. Epidemiology is the science of how we know in the real world if something is good for you or bad for you. And it’s best understood through example as the science of those crazy, wacky newspaper headlines. And these are just some of the examples.

These are from the Daily Mail. Every country in the world has a newspaper like this. It has this bizarre, ongoing philosophical project of dividing all the inanimate objects in the world into the ones that either cause or prevent cancer. So here are some of the things they said cause cancer recently: divorce, Wi-Fi, toiletries and coffee. Here are some of the things they say prevents cancer: crusts, red pepper, licorice and coffee. So already you can see there are contradictions. Coffee both causes and prevents cancer. And as you start to read on, you can see that maybe there’s some kind of political veilance behind some of this. So for women, housework prevents breast cancer, but for men, shopping could make you impotent. So we know that we need to start unpicking the science behind this.

And what I hope to show is that unpicking dodgy claims, unpicking the evidence behind dodgy claims, isn’t a kind of nasty carping activity; it’s socially useful, but it’s also an extremely valuable explanatory tool. Because real science is all about critically appraising the evidence for somebody else’s position. That’s what happens in academic journals. That’s what happens at academic conferences. The Q&A session after a post-op presents data is often a blood bath. And nobody minds that. We actively welcome it. It’s like a consenting intellectual S&M activity. So what I’m going to show you is all of the main things, all of the main features of my discipline — evidence-based medicine. And I will talk you through all of these and demonstrate how they work, exclusively using examples of people getting stuff wrong.

So we’ll start with the absolute weakest form of evidence known to man, and that is authority. In science, we don’t care how many letters you have after your name. In science, we want to know what your reasons are for believing something. How do you know that something is good for us or bad for us? But we’re also unimpressed by authority, because it’s so easy to contrive. This is somebody called Dr. Gillian McKeith Ph.D, or, to give her full medical title, Gillian McKeith. (Laughter) Again, every country has somebody like this. She is our TV diet guru. She has massive five series of prime-time television, giving out very lavish and exotic health advice. She, it turns out, has a non-accredited correspondence course Ph.D. from somewhere in America. She also boasts that she’s a certified professional member of the American Association of Nutritional Consultants, which sounds very glamorous and exciting. You get a certificate and everything. This one belongs to my dead cat Hetti. She was a horrible cat. You just go to the website, fill out the form, give them $60, and it arrives in the post. Now that’s not the only reason that we think this person is an idiot. She also goes and says things like, you should eat lots of dark green leaves, because they contain lots of chlorophyll, and that will really oxygenate your blood. And anybody who’s done school biology remembers that chlorophyll and chloroplasts only make oxygen in sunlight, and it’s quite dark in your bowels after you’ve eaten spinach.

Next, we need proper science, proper evidence. So, “Red wine can help prevent breast cancer.” This is a headline from the Daily Telegraph in the U.K. “A glass of red wine a day could help prevent breast cancer.” So you go and find this paper, and what you find is it is a real piece of science. It is a description of the changes in one enzyme when you drip a chemical extracted from some red grape skin onto some cancer cells in a dish on a bench in a laboratory somewhere. And that’s a really useful thing to describe in a scientific paper, but on the question of your own personal risk of getting breast cancer if you drink red wine, it tells you absolutely bugger all. Actually, it turns out that your risk of breast cancer actually increases slightly with every amount of alcohol that you drink. So what we want is studies in real human people.

And here’s another example. This is from Britain’s leading diet and nutritionist in the Daily Mirror, which is our second biggest selling newspaper. “An Australian study in 2001 found that olive oil in combination with fruits, vegetables and pulses offers measurable protection against skin wrinklings.” And then they give you advice: “If you eat olive oil and vegetables, you’ll have fewer skin wrinkles.” And they very helpfully tell you how to go and find the paper. So you go and find the paper, and what you find is an observational study. Obviously nobody has been able to go back to 1930, get all the people born in one maternity unit, and half of them eat lots of fruit and veg and olive oil, and then half of them eat McDonald’s, and then we see how many wrinkles you’ve got later.

You have to take a snapshot of how people are now. And what you find is, of course, people who eat veg and olive oil have fewer skin wrinkles. But that’s because people who eat fruit and veg and olive oil, they’re freaks, they’re not normal, they’re like you; they come to events like this. They are posh, they’re wealthy, they’re less likely to have outdoor jobs, they’re less likely to do manual labor, they have better social support, they’re less likely to smoke — so for a whole host of fascinating, interlocking social, political and cultural reasons, they are less likely to have skin wrinkles. That doesn’t mean that it’s the vegetables or the olive oil.

(Laughter)

So ideally what you want to do is a trial. And everybody thinks they’re very familiar with the idea of a trial. Trials are very old. The first trial was in the Bible — Daniel 1:12. It’s very straightforward — you take a bunch of people, you split them in half, you treat one group one way, you treat the other group the other way, and a little while later, you follow them up and see what happened to each of them. So I’m going to tell you about one trial, which is probably the most well-reported trial in the U.K. news media over the past decade. And this is the trial of fish oil pills. And the claim was fish oil pills improve school performance and behavior in mainstream children. And they said, “We’ve done a trial. All the previous trials were positive, and we know this one’s gonna be too.” That should always ring alarm bells. Because if you already know the answer to your trial, you shouldn’t be doing one. Either you’ve rigged it by design, or you’ve got enough data so there’s no need to randomize people anymore.

So this is what they were going to do in their trial. They were taking 3,000 children, they were going to give them all these huge fish oil pills, six of them a day, and then a year later, they were going to measure their school exam performance and compare their school exam performance against what they predicted their exam performance would have been if they hadn’t had the pills. Now can anybody spot a flaw in this design? And no professors of clinical trial methodology are allowed to answer this question. So there’s no control; there’s no control group. But that sounds really techie. That’s a technical term. The kids got the pills, and then their performance improved.

What else could it possibly be if it wasn’t the pills? They got older. We all develop over time. And of course, also there’s the placebo effect. The placebo effect is one of the most fascinating things in the whole of medicine. It’s not just about taking a pill, and your performance and your pain getting better. It’s about our beliefs and expectations. It’s about the cultural meaning of a treatment. And this has been demonstrated in a whole raft of fascinating studies comparing one kind of placebo against another. So we know, for example, that two sugar pills a day are a more effective treatment for getting rid of gastric ulcers than one sugar pill. Two sugar pills a day beats one sugar pill a day. And that’s an outrageous and ridiculous finding, but it’s true. We know from three different studies on three different types of pain that a saltwater injection is a more effective treatment for pain than taking a sugar pill, taking a dummy pill that has no medicine in it — not because the injection or the pills do anything physically to the body, but because an injection feels like a much more dramatic intervention. So we know that our beliefs and expectations can be manipulated, which is why we do trials where we control against a placebo — where one half of the people get the real treatment and the other half get placebo.

But that’s not enough. What I’ve just shown you are examples of the very simple and straightforward ways that journalists and food supplement pill peddlers and naturopaths can distort evidence for their own purposes. What I find really fascinating is that the pharmaceutical industry uses exactly the same kinds of tricks and devices, but slightly more sophisticated versions of them, in order to distort the evidence that they give to doctors and patients, and which we use to make vitally important decisions.

So firstly, trials against placebo: everybody thinks they know that a trial should be a comparison of your new drug against placebo. But actually in a lot of situations that’s wrong. Because often we already have a very good treatment that is currently available, so we don’t want to know that your alternative new treatment is better than nothing. We want to know that it’s better than the best currently available treatment that we have. And yet, repeatedly, you consistently see people doing trials still against placebo. And you can get license to bring your drug to market with only data showing that it’s better than nothing, which is useless for a doctor like me trying to make a decision.

But that’s not the only way you can rig your data. You can also rig your data by making the thing you compare your new drug against really rubbish. You can give the competing drug in too low a dose, so that people aren’t properly treated. You can give the competing drug in too high a dose, so that people get side effects. And this is exactly what happened which antipsychotic medication for schizophrenia. 20 years ago, a new generation of antipsychotic drugs were brought in and the promise was that they would have fewer side effects. So people set about doing trials of these new drugs against the old drugs, but they gave the old drugs in ridiculously high doses — 20 milligrams a day of haloperidol. And it’s a foregone conclusion, if you give a drug at that high a dose, that it will have more side effects and that your new drug will look better.

10 years ago, history repeated itself, interestingly, when risperidone, which was the first of the new-generation antipscyhotic drugs, came off copyright, so anybody could make copies. Everybody wanted to show that their drug was better than risperidone, so you see a bunch of trials comparing new antipsychotic drugs against risperidone at eight milligrams a day. Again, not an insane dose, not an illegal dose, but very much at the high end of normal. And so you’re bound to make your new drug look better. And so it’s no surprise that overall, industry-funded trials are four times more likely to give a positive result than independently sponsored trials.

But — and it’s a big but — (Laughter) it turns out, when you look at the methods used by industry-funded trials, that they’re actually better than independently sponsored trials. And yet, they always manage to to get the result that they want. So how does this work? How can we explain this strange phenomenon? Well it turns out that what happens is the negative data goes missing in action; it’s withheld from doctors and patients. And this is the most important aspect of the whole story. It’s at the top of the pyramid of evidence. We need to have all of the data on a particular treatment to know whether or not it really is effective. And there are two different ways that you can spot whether some data has gone missing in action. You can use statistics, or you can use stories. I personally prefer statistics, so that’s what I’m going to do first.

This is something called funnel plot. And a funnel plot is a very clever way of spotting if small negative trials have disappeared, have gone missing in action. So this is a graph of all of the trials that have been done on a particular treatment. And as you go up towards the top of the graph, what you see is each dot is a trial. And as you go up, those are the bigger trials, so they’ve got less error in them. So they’re less likely to be randomly false positives, randomly false negatives. So they all cluster together. The big trials are closer to the true answer. Then as you go further down at the bottom, what you can see is, over on this side, the spurious false negatives, and over on this side, the spurious false positives. If there is publication bias, if small negative trials have gone missing in action, you can see it on one of these graphs. So you can see here that the small negative trials that should be on the bottom left have disappeared. This is a graph demonstrating the presence of publication bias in studies of publication bias. And I think that’s the funniest epidemiology joke that you will ever hear.

That’s how you can prove it statistically, but what about stories? Well they’re heinous, they really are. This is a drug called reboxetine. This is a drug that I myself have prescribed to patients. And I’m a very nerdy doctor. I hope I try to go out of my way to try and read and understand all the literature. I read the trials on this. They were all positive. They were all well-conducted. I found no flaw. Unfortunately, it turned out, that many of these trials were withheld. In fact, 76 percent of all of the trials that were done on this drug were withheld from doctors and patients. Now if you think about it, if I tossed a coin a hundred times, and I’m allowed to withhold from you the answers half the times, then I can convince you that I have a coin with two heads. If we remove half of the data, we can never know what the true effect size of these medicines is.

And this is not an isolated story. Around half of all of the trial data on antidepressants has been withheld, but it goes way beyond that. The Nordic Cochrane Group were trying to get a hold of the data on that to bring it all together. The Cochrane Groups are an international nonprofit collaboration that produce systematic reviews of all of the data that has ever been shown. And they need to have access to all of the trial data. But the companies withheld that data from them, and so did the European Medicines Agency for three years.

This is a problem that is currently lacking a solution. And to show how big it goes, this is a drug called Tamiflu, which governments around the world have spent billions and billions of dollars on. And they spend that money on the promise that this is a drug which will reduce the rate of complications with flu. We already have the data showing that it reduces the duration of your flu by a few hours. But I don’t really care about that. Governments don’t care about that. I’m very sorry if you have the flu, I know it’s horrible, but we’re not going to spend billions of dollars trying to reduce the duration of your flu symptoms by half a day. We prescribe these drugs, we stockpile them for emergencies on the understanding that they will reduce the number of complications, which means pneumonia and which means death. The infectious diseases Cochrane Group, which are based in Italy, has been trying to get the full data in a usable form out of the drug companies so that they can make a full decision about whether this drug is effective or not, and they’ve not been able to get that information. This is undoubtedly the single biggest ethical problem facing medicine today. We cannot make decisions in the absence of all of the information.

So it’s a little bit difficult from there to spin in some kind of positive conclusion. But I would say this: I think that sunlight is the best disinfectant. All of these things are happening in plain sight, and they’re all protected by a force field of tediousness. And I think, with all of the problems in science, one of the best things that we can do is to lift up the lid, finger around in the mechanics and peer in.

Thank you very much.

(Applause)

On the old blog, the idea of Sunday Blasphemy as stolen from Brett Booth of Demonpuppy as part of a rubber-duck experiment in finding a place in the universe. However the attempt to maintain this ceased when it was rationalized one’s spirituality has no bearing on politics. Wrong, personal views have everything to do with how one interprets the world. Futhermore, the name “Prick-Eared” was chosen as a way to remove oneself from the implied dog-centric suggestion “Little Heelers” harboured.

However, blogging about dogs is tiring; and there are ideas in this noggins which are never really expressed in real life. Besides, since everyone is self-entitled to being intelligent with a university degree as proof these days, it is impossible to have an actual discussion. No wonder why people prefer to reduce themselves to hockey, sex and drugs. It wouldn’t hurt to diverge from time to time.

Yesterday, PZ Myers on his Freethought blog decided to revive C.C. Moore’s tradition of publishing letters in a newspaper, which can now be found in Letters of an Atheist Nation. Instead of submitting a revised essay to Myers, I decided to push a draft on this blog.

Growing up in a Mennonite household, I was raised ignorant of the Bible. Sure, there might be children’s books on Moses or the Garden of Eden lying about, but so were many other moralistic stories derived from First Nations mythologies, fear-mongering tales from the Great North passed down through generations of Inuits and lessons were learnt from Aesop’s Fables; which all peppered everyone’s childhood. However, like many credobaptists, my mother believed religions and politics were not to be discussed at the dinner table, and it was a personal affair. Personal affairs, indeed. Now, depending on the family, politics and religions could be introduced upon the Age of Reason. For some, this could be as early as 12, or just before it’s time to move out. She chose to hide our ethnicity and religious backgrounds until about two years into college. Fear of religious prosecution by the evangelists and fear of being called a heathen among our own kind was the primary motivator. As a result, an atheist was raised.

However attempts to instill religious values did not go unheeded. It was with great persistence, the adults tried to teach the values of the Bible; but they could not answer the questions of the curious mind of a child who always asked “Why?” When it became obvious the educators became hostile, Biblical studies was dropped as it became obvious most people parrot the Holy Book; and if a child is not satisfied with the explanations he had received, it is not a good source of literature to teach. So, from the get-go, I was rather scientifically-orientated.

But when contested, I wasn’t mature enough to defend my position. Growing up in Alberta, there were many fundamentalists; and some of them were quite intelligent who used science to tailor their beliefs. Oddly, the best allies in the name of atheism were a Jenovah’s Witness, who I suspect doesn’t really buy into the doctrine but converted for a different reason, and an American draft dodger. Nevertheless, atheism was tightly associated with anti-Semitism; and if the fact Hitler was a professed Catholic in his opus magnum, Mein Kampf, was made known, then such accusation would had been quickly put down. Also, quantum physics was often used as proof God exists which seemed bizarre to me since the argument could be applied to any deity; but philosophy was not my forte, so the Russell’s Teapot argument didn’t enter the picture. So, while shots were fired, the defense weren’t well fortified.

By the time the Mennonite origin was revealed, the post-modernist doctrine infested liberal arts and has began to infiltrated the sciences; and its relativist agenda slowly crept into the corners of every classroom. Grappled by the notion every truth is of equal merit, it was a struggle finding a place in the world as an agnostic; since after all, if everything is relative, surely there must be something to the idea of a Creator even if it is indeed the Flying Spaghetti Monster. Isn’t that what our professors would like to experiment with? To be honest, philosophy was a struggle. The course was a breeze, but the only thing which made sense was David Hume, Karl Popper and Chomsky; everything else was wishy-washy. It became extremely difficult not to discard the course as bullshit, and run the risk of being failed by an already pissant Teacher Assistant. See, the name of the game for every Undergraduate is to stay on the good side of the Teacher Assistant. Thou shall not think for himself. As a result, for the next few years, I remained enstrangled about mankind’s place in the universe.

There was never a rejection of a Christian God; because there was no Abrahamic God to begin with. When presented with the idea of a deity at a young age, it was immediately questioned why one religion is more valid than any other religions. After all, I knew Yahweh created Adam and Eve, but the Raven also created the world; so did the muskrat. Why is Christianity or Islam is more right than Hinduism or Buddhism? Or even Taoism and folk religions? Everyone is striding in faith. Isn’t easier just to make peace with the possibility they are all equally invalid? It’s time to check into a system which is self-correcting.

That is not to say the Bible wasn’t read. I bought the Qu’ran upon checking into campus the first day and started reading it. When placed side by side with the Bible, the Qu’ran is actually a more humane scripture. The Christian concept of God is a dick compared to the Muslim concept of the same deity. The religious laws, however, never sat well with me. Daoism was an interesting experiment; and so was neopaganism. So, a spiritual journey did take place.

As a reformed agnostic in University, it had a weird effect. While conceding a supernatural being might exists, the blame game came along since someone oughta be accountable because an individual can only do so much. In addition, other people’s failures were taken personally. It took a few years before consoling with science re-entered the misanthropic picture. Delightedly, upon picking up the slack on the latest data and theories explaining people’s behaviours as a collective, I became more people-positive; and hope for humanity’s future was restored.

That being said, there is no place for post-modernism in the academia, nor in the real world. Science is rooted in facts. There is nothing grey about the hard sciences. The reason why relativism arose is because the authorities have participated in fraudulent activities and lied to the general public, thus screwing us over; and people cheer for sticking it to the man. So while sentiments of anti-intellectualism are valid; the actions are not. It is unfortunate political correctness runs amok and shifted the sciences from explaining discoveries and questioning the consequences to educating people how not to do things. There is a place for relativism, and it lies in resolving uncertainties. It does not however have a place in determining facts.

My stance? There is no creator. We neither can prove nor disprove the concept of a supernatural being. However, the odds of improbability of a creator is so high, it would quickly destabilize the engines of the Heart of Gold and send it into oblivion. Just because a teapot could be floating in space orbiting somewhere, does that means we all have to rush out to start a cult of worshipping a celestial teapot? It is absolutely absurd. What about the origin of the universe? The Big Bang is the first recorded moment of time we know of. Everything before the Big Bang was eradicated in the process. After all, there are two schools of thought, one seem to be pointing the compass toward the cosmological model of an oscillating universe; this has a philosophical appeal to many people. The other follows the fate of a heat death where the universe continues to expand until it is too cold to sustain life. Both theories have weight behind them, one relying on loop quantum gravity to support it; and the other rests on the laws of thermodynamics. Stephen Hawkings highlighted the rivalry, “Personally, I’m sure that the universe began with a hot Big Bang. But will it go on forever? If not, how will it end? I’m much less certain about that. The expansion of the universe spreads everything out, but gravity tries to pull it all back together again. Our destiny depends on which force will win.” Regardless, as Carl Sagan said, “The cosmos is all that is or ever was or ever will be.” Carl Sagan’s answer to the question of the cosmos is strangely satisfying; nor is there anything bleak about it, but rather there’s a beauty in such simplicity.

Evolution is bleak? Nature is too gory and ruthless? Fear not, child, if our ancestors did not have the altruism of kinship built into our genetic code, constantly being selected for, then we would not be here. One can find similar examples of kinship, mutualism and symbiotic relationships all over the animal kingdom. If this does not offer a glimmer of hope, lend me your ears.

Every one of us is the result of an unbroken lineage because our ancestors adapted and reproduced successfully. Each individual born in the world won the lottery of gene recombination, implantation rejections and miscarriages of having a shot at leading a fulfilling life. We all benefit from lending hands to one another. Society is founded upon ideas handed down to us by the geniuses of the past, and the previous generations sponsored these ideas and to prosper. These systems are built upon the backs of labourers and supported by the pillars of agriculture. Our legacies are recorded and is passed onto our children and the remaniements are left behind for future generations to discover. Cultures and values are passed on and gradually change with time. As one can plainly see, even the childless are still contributing to our race. Even if human civilization ceases to exist, we give way to new species; and ultimately after the demise of the planet, our molecules continue on in another form. A world devoid of magical-thinking is neither morose, nihilistic nor self-destructive, the future is bright and promising. The wondrous beauty of nature and mysteries of space and time is something to behold, to be revered, and to explore; even if they are beyond the grasp of our understanding. One doesn’t need God to give hope, continuity does. It is selling ourselves short to attempt to explain the gaps with the supernatural.

However it seems rather ridiculous to reconcile as an agnostic. In essence, we are all agnostics. Some are certain there is a god or goddess; yet rejects all other possibilities. Others are open to the possibility there might not be a creator or a deity. However atheists liberated themselves of the internal conflict by removing the question from the picture altogether.

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