Tuesday, December 23, 2008

Can you just be a little bit organic? Sustaining the Unsustainable.

You can't be a little bit pregnant, you either are or you aren't.
- Bob Flowerdew, Radio 4's 'Gardener's Question Time', talking about organic gardening.

I've never bought into the idea of 'organic' produce - there are some solid organic principals and guidelines which I think are Good Things, like reducing pesticides and biodiversity, but Organic True Believers™ would have no truck with my post-modern woolly organicity.

I'll also say, I've never trusted the Organic High Priests like the Soil Association, whose take on organic food has been put through the PR mill, so that the perceived benefits are trotted out as fact and exaggerated and whose scientific credentials leave a lot to be desired. You'll remember, no doubt, that The Soil Association awarded Gillian McKeith its Consumer Education Award 2005 - information the Soil Assoc has decided should no longer be on their website.

The Soil Association's current resident nutritionist, Shaun Heaton, doesn't seem much better - cue Dara O'Briain's nutritionist gag.

Lines like:
Organic food contains fewer pesticide residues. []. Don’t wait, as unfortunately many people do, to get diagnosed with cancer before you get interested in real food.
Interesting reasoning.
Organic food contains no artificial additives such as sweeteners or colours, which a major new study has now unequivocally linked to hyperactivity, learning and behavioural problems in children.
Unlike those nasty aspartame carrots that are all the rage?
Organic food contains more nutrients, as confirmed again by the largest study of its kind just released, showing 20-80% more nutrients in organics.
The British Nutrition Foundation would say otherwise:
• There is no evidence to show that crops grown organically have a better nutrient content than those produced non-organically. However, it has been acknowledged that little research has been conducted to date and much of the available scientific information is out-dated or based on inadequate study design.

Historically, the cost of organic food has been considerably higher than ordinary food, but this gap has closed significantly over the last number of years. Food prices in general have risen and with the current economic credit crunch, people are tightening their belts.
What will be first against the wall? People's principals. So much so, according to The Times, that organic farmers are lobbying government to allow them to take an Organic Holiday, so that they can buy the much cheaper ordinary feed during these hard times. According the newspaper:
Sales of organic food slumped 10 per cent in the 12 weeks up to the end of November, according to the latest figures from the consumer researchers TNS. Overall food sales over the same period were up 6 per cent

To me, this idea is nonsense. One concept that has been used frequently with organic farming is the idea of sustainability. Usually this has been in the context of biodiversity, protection of hedgerows, maintaining the wildlife equilibrium etc - all good things, but in fact, of questionable importance if the food you are producing is not commercially viable. You end up with less 'conventional' land to provide more food. Sustainability means being able to sustain your business during tough times. How on earth can you forgo your principals? I don't think they'll be given leave to do this - the main problem I see is that it will be a PR disaster.

Firstly, you are offending your True Believers™, the people who have completely bought into the Organic Religion. They will not tolerate a change to the Holy Book, and it could lead to a split. The word 'organic' will lose its meaning and brand identity (Chemists would argue this has already happened once).

Secondly, you've already lost the people fleeing to Lidl who weren't true believers, and now that they've been away, it'll be difficult to get them back. The beliefs of animal welfare and no pesticides were 'nice thoughts' for them, perhaps they bought organic as a social status symbol or because they had a few extra pennies. I would have thought someone buying organic would be subject to some sort of cognitive dissonance if they went back to normal food. How could they justify their previous lavish expense? Can they really taste a difference?

How many of the farmers are True Believers™ and how many converted to organic because at one time it was a lucrative business move? Can these farmers be trusted to maintain the scrupulous organic standards when bills are stacking up and produce is not going out of the gate? This is not to characterise farmers as underhanded, merely to present the situation as being a truly difficult decision.

According to the Organic Farmers and Growers statement on the Times story, no approach has yet been made to DEFRA, although they do state:
It is, however, fair to say that the broad aims would be to allow farmland to remain organic, even if the animals on it were to be fed on non-organic rations for a limited time, thereby enforcing the removal of the animals from the organic system.

So you can have organic farmland, with normal livestock on it eating normal foodstock and when times get better, jump back into the Organic circle. Normal farmers trying to get into organic farming have to maintain their land as organic for three years before they get the cert. If you are in the year 2 of your 3 year run, does it count? IF so, it makes a mockery of the whole 3 year hoop.

Without any sense of irony, the OGF finish their statement with the following:
The industry’s aim is to protect the organic system for the welfare and environmental benefits it brings and ensure that progress made in expanding this sustainable method of farming is not lost.

There's that 'sustainable' word again. Allow me to translate
The industry's aim is to sustain the unsustainable.

BPSDB

Tuesday, December 16, 2008

Science Museum carries on MMR hoax.

This is the tenth year of the MMR Hoax.

Of course, the media - who according to Dr Ben Goldacre in the above link are largely responsible - have switched allegiances and act as if their constant publishing of nonsense and scare stories relating to MMR never happened.

At least, after ten years, the media will now admit (in accordance with what respectable health practitioners have been saying for a decade) that it was a hoax - the NHS website on MMR states the site is no longer being updated and the Department of Health has announced an MMR vaccine catch-up campaign.

The media, that is, apart from the Telegraph, but it's quality of science reporting has diminished so fantastically over the last while, this isn't surprising.

Levels of measles have been rising over the last decade, but perhaps we are at a turning point, as this week, in Scotland the percentage of under fives having received the first dose stands at 95%, for the first time.

Nonetheless, one of the many hangovers to come-out of the MMR booze-up was JABS - Justice Awareness, Basic Support. This is a 'support-group' for vaccine-damaged children, or to put it cynically, people whose children have developed problems, which the parents put down to vaccines, irrespective of the evidence. JABS became synonymous with an anti-MMR stance (indeed anti-vaccine in general), and so no amount of evidence would ever convince them of its relative safety. Many articles and blogs have criticised JABS for its terrible 'science' or its abusive nature towards anyone who dares suggest that MMR and autism are not connected.

The BBC have stopped linking to JABS after being made aware of the site's contents and there has even been a piss-take set-up. I wrote about their odd ways and their connection with the truly out-of-this-planet-utterly-bananas site, Whale.to earlier this year.

With your monitor set to 'Weird Mode' have a look at a JABS conversation here.

Indeed.

The Science Museum is one of London's great free museums, holding over 300,00 artefacts of scientific and medical significance. The website also contains a section called 'Antenna' which is the Science News section, with a special section on MMR:
For three months you've been telling the Science Museum your concerns about MMR - the measles, mumps and rubella triple vaccine.

Armed with your questions, fears and arguments a team from the Museum set off to interrogate the major players in the controversy.

Controversy? Not for a long time. Hoax would be a better choice of word.

Clicking on "What about single jabs?" and then "Where can I get them?", the Science Museum website happily suggests emailing JABS for some advice. The Science museum suggests contacting an anti-vaccine pressure group on advice for vaccines. Perhaps the Science Museum should be weighing up government advice and making a decision on the evidence rather sending parents, who are trying to do the best by their kids, to rather odd inhabitants of JABS-world.

The JABS website itself states:
JABS is not primarily a provider of vaccine information but a support group of parents who feel their children have suffered a reaction or have been severely damaged by a vaccine

... so what is the point of sending people there who are trying to find out about single vaccines? Despite this website claim, the Science Museum has page with a photo of Jackie Fletcher (JABS co-ordinator) stating:
Jackie Fletcher of vaccine-damage support group JABS also offers advice for parents regardless of whether they are opting for single jabs or the full MMR.

How balanced an opinion do you think you will get from JABS on this issue?

It's clear the Science Museum needs to completely update and revamp its MMR site, and do its part to relegate the MMR hoax to science history.

EDITED 17/12/2008: If you would like to let the Science Museum know about their backwards stance on this issue, the contact details are here.
Hat-tip to Duck & Tristan @ Bad Science.


BPSDB

Sunday, December 14, 2008

Meditation vs Medication

By Guest Blogger, Redlan.

Media reporting of science is a beautiful thing to behold, and usually dreadfully and woefully wrong. Read the original study and you are pretty much guaranteed to find that the study found almost the complete reverse of what was reported.

The Daily Mail recently reported that "Meditation 'as effective as medication' in treating depression" and the BBC followed with "Group Therapy 'beats depression'"

As effective? Beats depression?

On this one they might have redeemed themselves though, as they’re both only half wrong. What they are talking about is something called Mindfulness-Based Cognitive Therapy or MBCT. Sounds really sciencey if we just use letters. It’s a form of CBT (cognitive behaviour therapy) which is a therapeutic technique that aims to correct behaviours, emotions and thoughts through a goal-orientated approach. It’s actually an umbrella term for a group of cognitive and behavioural approaches, of which MBCT is one. The paper that prompted both the headlines is Mindfulness-based cognitive therapy to prevent relapse in recurrent depression by Kuyken et al from the University of Exeter.

The 'meditation' bit comes about because the therapy uses some meditation techniques. But do not be fooled - MBCT isn’t meditation, it’s a therapy. We’ll deal with the Daily Mail headline a bit later. Never mind whose meditation techniques it uses, does it actually work? For now let’s look at the results:

The Daily Mail and the BBC don’t quite agree on how effective it is. The Daily mail says
47% of people with long-term depression who underwent the therapy suffered a relapse, compared to 60% of those taking anti-depressant drugs.
And the BBC says
The trial of 123 people found similar relapse rates in those having group therapy and those taking drugs.
So what’s going on? The Daily Mail seems to imply that MBCT is better, while the BBC says they are similar. Is 47% really similar to 60%?

The abstract says
MBCT were 47%, compared with 60% in the m-ADM group (hazard ratio = 0.63; 95% confidence interval: 0.39 to 1.04)
The Daily Mail got the numbers right. What about the stuff in brackets? The hazard ratio is similar to, but not the same as relative risk. In this study the hazard ratio is a measure of the effect of MBCT on relapse rates. The 95% confidence interval is an estimate of the hazard ratio you would get if you repeated the experiment. But there is something missing…

Why haven’t they quoted the statistical significance usually denoted as p? Did they forget? Or not think it was very important?

Statistical significance is used to test the null hypothesis – i.e. the hypothesis that there is no effect. I worked out p using chi-squared test of significance. I got p=0.12. Normally in biomedical sciences p<0.05 is considered to be significant, and so by that standard we have a null result. In other words, for this experiment, 47% is not significantly smaller than 60%. So the BBC would appear to have got it right. Hurrah for the BBC!

The NHS website, Behind The Headlines, also discusses this paper. It rightly points out the flaws in the BBC’s and Daily Mail’s reporting. It then goes on to give a few more details about the study. The subjects had received MBCT treatment for the previous six months and were now in either full or partial remission and taking antidepressant medication. There were then randomised to receive a further 8 week course of MBCT or treatment as usual, which meant continuing with anti-depressants. The treatment arm were also offered support to withdraw or lower medication.

So what exactly is this a study of? The rather innocent sounding (though wordy) title of Mindfulness-based cognitive therapy to prevent relapse in recurrent depression, doesn’t really do it justice.

So which one is the control group? Which event do you think might have the biggest impact amongst people with depression? Being told that you were going to get another course of MBCT? Or being told that you weren’t going to get one? Participants would have to be willing to participate in another course of MBCT before they could be enrolled in the study.

In the field of mental health, the placebo effect is very pronounced. It is typically damned hard for pharmaceutical companies to demonstrate that their latest mood enhancing wonder drug works any better than the placebo. Tell someone that they are going to receive “therapy” to make them better, and lo and behold they start to get better.

Read the literature and you will find that CBT is described as a useful addition to normal drug treatments. So bearing in mind that the placebo effect is very pronounced, what are all these treatments tested against in the control group? Sham therapy? Self help groups? Going to the pub with some friends?

Nope.

They are all compared to treatment as usual, which usually means treatment with anti-depressants. So the effect could simply be down to the “therapeutic relationship” and nothing to do with the actual therapy. It’s not the therapy that’s making you better, it’s the hour a week you have with your “specialist” telling you that his therapy will make you better, that is making you better.

Patients getting CBT do better than patients who don’t get CBT, but is it the CBT itself, or the therapeutic relationship that is making them better? It's impossible to tell, until someone devises a placebo based control group. I haven’t found one, but then I don’t have the resources to run systematic searches and analyse the results. If you have a spare afternoon, I guess you could have a some fun searching PubMed.

Now back to that Daily Mail headline…

Meditation 'as effective as medication' in treating depression

Really? Is meditation as effective as medication? Well, probably not according to the Cochrane Library. They did conclude that meditation was better than no or minimal treatment on self-related depressive symptoms, but not as good as psychological treatments. So it would appear that patients believe that psychological treatments work better than meditation, which works better than nothing. However doctors weren’t quite so sure - the doctors only noticed a non-significant trend that meditation was better than nothing, and they couldn’t tell the difference between psychological treatments and meditation.

Newspapers and the media like to sell us simple stories. If they resonate with a strongly held social belief, then all the better. Usually the real picture is more complicated, and whether we like it or not the “experts” often do not know the answers. What is lost sometimes in the story is the fact that science is not neutral or unemotional or unbiased. It is after all perpetrated by humans. So let’s just ask a couple questions…

Why would the researchers of the paper behind the headlines, neglect to mention whether the result was significant or not in the abstract?

I wonder if they would have mentioned p if the result had been significant? It’s normal practice to state whether the result was significant or not. Try finding a paper without p being mentioned. I do find the paper confusing, because I can’t work out what hypothesis they are testing. Maybe they don’t mention p because the study appears to be designed to produce a null result anyway.

Why is CBT always tested against Treatment as Usual (TAU)? Sure it may be hard to devise and agree on what would constitute a proper placebo, but how else are you going to know whether CBT is not simply itself a placebo? I guess though you’d have to be brave to design a study knowing it could end up disproving years of training and research.

Of course, that's no reason not to do it.
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Redlan
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BPSDB

Thursday, December 4, 2008

Napiers Homeopathy - treating the individual person or just True Believers™?

OK,OK, it's a loaded question, it may not surprise you to know it's the latter. To be honest, I'm bored of homeopathy. Bored. Bored. Bored.

I'm bored of its nonsensical, illogical, deceitful, uncritical, confused, law-breaking, twisted, underhand, conspiratorial, paranoid True Believers™ who are able to preach their religion in the media, often without any critical appraisal by the cut-and-paste journalistas.

Nonetheless, to labour the point heavily, one of the mantras trundled out time and time and time again is that homeopathy is a holistic medicine. (It is, in reality, neither of those things, but I digress). It treats the person, not the symptoms; it (depending on who you talk to) readdresses the imbalances in the energy fields allowing the body's natural defences to get to work and recreate health. It is impossible to test by the scientific method because it doesn't work the same way as conventional (euggh) medicine.

All of the above are trotted out regularly by True Believers™ of homeopathy and yet a little observation produces a wealth of information that states otherwise.

Why don't we all get together and go to Napiers "Homeopathy for Families" workshop in January 2009?
Tickets: £20 includes a complimentary bottle of the homeopathic remedy Arnica.

OK. Now go through the old 'treat the person not the disease' mantra again and explain how giving everyone a bottle of indistinguishable sugar pills labelled arnica will do that?

Where is the 'taking patient medical history', looking at emotional problems and lifestyle and all the other smoke-and-mirrors rhetoric used to pretend that there is any substance to this quackery? Nowhere. Just give 'em arnica and they'll be fine. (Or more correctly, just give 'em some sugar pills, doesn't matter what the label says, it won't do anything other than a placebo effect).

In a similar vein, sharp-shooting investigative journalist (read: uncritical cut-and-paster) James Connell has offered another fine example of Dr* T's First Theory in the Worcester News:
Is homeopathy the way to beat winter colds and the flu?

No it isn't. However, here we are again with our questioning on 'treating the whole person, not the disease/symptoms'.

From the uncritical, lazy, rehashed, unresearched, unintelligent, unscientific, unoriginal(!) piece, I'll let you perform your own critique on these two sections:
Homeopathy treats the whole person, not just a symptom or disease. Homeopaths say it therefore has the potential to help people with a wide range of physical, psychological and emotional problems.

and
GELSENIUM: This is considered to be the best remedy for flu when the symptoms include a dull and sluggish feeling with a dull ache at the back of the neck

Up is down, black is white, square is round - only easy to reconcile for the True Believers™.

BPSDB

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