Tuesday, 29 June 2010

Homeopathy and the NHS - update

In May, the British Medical Association's annual conference of junior doctors declared that homeopathy is witchcraft and now the BMA’s conference in Brighton has voted overwhelmingly against commissioning or funding for homeopathic remedies or homeopathic hospitals in the health service. They also want training posts in homeopathic hospitals scrapped.

What’s more, pharmacists should remove homeopathic remedies from their shelves because this strongly suggests to the public they are medicines. Instead they should be put in a section marked ‘placebos’.

This may well be a step too far because, as we know, Boots doesn’t sell homeopathy because it works, they sell it because people like to buy it. In case you’ve forgotten - a spokesman for Boots said: "I have no evidence to suggest that [homeopathic remedies] are efficacious. It's about consumer choice and a large number of our customers think they work."

Dr Mary McCarthy, a GP at the conference, said: ‘We are not asking for homeopathy to be stopped and it will allow those who want to do it to continue to use it. What we are asking is that it’s not funded by the scarce NHS resources.’

OK, so it’s not witchcraft

BMA junior doctors’ committee vice-chair Tom Dolphin, who first proposed banning homeopathy at the BMA annual junior doctors conference in May, said: ‘I got into trouble for saying at the juniors conference that homeopathy is witchcraft.

'I take that back and apologise to the witches I apparently offended by association. Homeopathy isn’t witchcraft — it is nonsense on stilts. It is pernicious nonsense that feeds into a rising wave of irrationality that threatens the hard won gains of the enlightenment, and the scientific method.’

He warned that society risked ‘sinking back into a state of magical thinking, where made-up science passes for rational discourse, and wishing for something to be true counts as proof’.

Tell it like it is, Tom.

There were, of course, supporters of homeopathy at the conference and protesting outside.

Dr David Shipstone, a urologist, said it would be unfair to pick on homeopathy as there were plenty of other treatments which were used by doctors despite a lack of categorical evidence they worked. He said: "What is valid scientific evidence? Academics can argue about it all day."

It’s not about valid evidence in this case, but about the total lack of evidence even after 200 or so trials. Unless by ‘valid’ he means ‘imaginary’ – or possibly homeopathic evidence is so dilute that it contains no evidence at all.

BMA board of science chair-elect Averil Mansfield said: ‘What we want to be supporting and promoting is things that have scientific evidence. The resources are small in the NHS and that I think has to be our central priority.’

The Department of Health said it was looking into the issue:
"The department is considering issues to do with homeopathic remedies and hospitals as part of the government's response to the Science and Technology Committee's report on homeopathy. The response will be issued soon."

Saturday, 26 June 2010

Homeopathy Is Witchcraft Part 2

Tory MP David Treddinick is calling for an Early Day Motion (EDM). He has found a study that apparently shows homeopathy is beneficial in the treatment of breast cancer.

The Abstract of the Texan study begins: 'The use of ultra-diluted natural products in the management of disease and treatment of cancer has generated a lot of interest and controversy'.

In other words, here we go again.

This is the EDM (285): That this House welcomes the study published in the International Journal of Oncology, 2010 Feb; 36(2): 395-403 which revealed that homeopathic remedies have a beneficial effect on breast cancer cells; notes that researchers at the University of Texas conducted an in vitro study to determine whether products prescribed by a clinic in India have any effect on breast cancer cell lines; further notes that the researchers studied four ultra-diluted remedies, carcinosin, phytolacca, conium and thuja against two human breast adenocarcinoma cell lines, MCF-7 and MDA-MB-231 and a cell line derived from immortalized normal human mammary epithelial cells, HMLE; observes that the remedies exerted preferential cytotoxic effects against the two breast cancer cell lines, causing cell cycle delay/arrest and apoptosis; believes that the findings demonstrate biological activity of these natural products when presented at ultra-diluted doses; and calls for further research in this important area. (my italics)

Treddinick also cites trials on the efficacy of homeopathy in the treatment of depression and primary insomnia.

In May this year, the British Medical Association's annual conference of junior doctors declared that homeopathy is witchcraft and public money should not be spent on it.

In February, a report by parliament's science and technology committee stated that: 'the NHS should cease funding homeopathy. It also concludes that the Medicines and Healthcare products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims without evidence of efficacy. As they are not medicines, homeopathic products should not longer be licensed by the MHRA'. Tredinnick disagrees.

(I covered both of these events in Homeopathy is Witchcraft Part 1.)

It's not the details of this particular study that interest me here. Other bloggers have already taken it apart and Simon Singh debated homeopathy with Tredinnick on Radio 4.

Tredinnick is using the now familiar mantra of "the jury is still out" and "we need more research". Yet again, this mythical jury hasn't reached a decision because homeopaths haven't got the result they want. After 200 plus trials, homeopathy has still not been proven to be better than placebo. That's like a criminal being found guilty 200 times and continuing to appeal.

There are two mutually incompatible approaches here. Scientists and their supporters are patiently quoting evidence and scientific methodology. Homeopaths and their supporters are using the tactics of a small child trying to wear its parents down. Tredinnick's debate will follow the well-worn path of scientists presenting the evidence and his side saying 'Yes, but...'.

No matter how many studies show that homeopathy doesn't work, its proponents will never give up. It's a fine example of cognitive dissonance. In other words, when they are presented with evidence that contradicts their beliefs, they put their fingers in their ears and go la la la la la.

Homeopathy is essentially a faith-based position. Like religion, scientists should perhaps deal with it by taking a secular position. If people want to pay for homeopathy and other alt med, despite all the evidence, that's really up to them. Like secularists try to do with religion, scientists and those of us who care about evidence should perhaps be trying to keep alt med out of public life. With religion, this means trying to stop it having power and influence in government, policy making, law, healthcare, education and so on. People can believe whatever they like but public money should not be spent on it. In alt med terms, it means making sure the NHS does not waste its limited resources on unproven remedies - making sure that public money is not wasted.

Like religion, belief in alt med is not going to go away no matter how hard we try. While it's important to demolish false claims and to educate the public, the most pressing current battle is for the NHS. Perhaps now it's time to focus our campaigning energy wholly onto the NHS as long as homeopathic effects are unproven.

Tredinnick said on Radio 4 that the UK is behind other countries, like France, who have embraced homeopathy. I'd rather think of it as us being ahead of the game but staying there is far from assured.

If you want to write to your MP about the EDM, you can find out how to contact them here.

Thursday, 17 June 2010

Circumcision and sexual injuries

A study called Circumcision and Reduced Risk of Self-Reported Penile Coital Injuries published in the Journal of Urology recently looks at whether circumcision reduces the incidence of injuries to the penis during sex, which may increase the risk of HIV infection. It found that the incidence of injury was less in circumcised than uncircumcised men.

Between 2002 and 2005, 2,784 men aged between 18 and 24 in Kisumu, Kenya were randomized into two groups, immediate circumcision and delayed circumcision after two years.

Injuries were classified as 1) penis feels sore during sex 2) penis gets cuts, scratches or abrasions during sex and 3) penis bleeds after sex. At the start of the two-year period, 64.4% of the men reported injuries and 10.5% reported all three. Having two or more sex partners in the last 30 days, applying substances to the penis before sex and having ulcers increased the risk of injury. Increased age was associated with increased risk, possibly because of 'a broader range of sexual practises'.

Any conclusion that circumcision in itself reduces injury risk is not substantiated by the research, however.

Both groups had intensive STI and HIV risk reduction counseling and were provided with unlimited free condoms. The prevalance of STIs decreased, condom use increased and reporting multiple sex partners decreased. After two years, it was found that circumcision, condom use, being married or living with a partner and cleaning the penis within one hour of sex reduced injury.

At the beginning, the 64.4% reporting injuries split into 65.1% of circumcised and 60% of uncircumcised men. After two years, 31% of circumcised men and 42.8% of uncircumcised still reported injuries.

A few points:

The incidence of injury was almost the same in circumcised and uncircumcised men at the start of the trial which would suggest that it was something else that happened during the trial that caused the reduction.

The groups were not divided into men having sex with men and with women. The assumption is that all of the men's partners were female.

Injuries and sexual practices were self-reported. The types of sexual practice were not recorded. There was no enquiry into why injuries were so high to begin with or how conselling may have influenced sexual practices - or the self-reporting of them - although the conclusion admits the need to verify the injuries and questions whether familiarity with study questions may have had an influence. Why the injuries were not verified during a trial based on counting them and why familiarity was not factored in at the start are not clear if they were going to undermine the findings. It is also not possible to separate out the effects of counselling and condoms.

50% of circumcised men reporting injuries at the start were still reporting injuries at the end of the trial which suggests that other factors are involved in injury reduction.

There's a bit of an anomaly in the table showing condom use. At the start of the trial, 1010 men hadn't used condoms at their last sexual encounter; by the end of the trial, this had fallen to 259. However, 765 had used a condom the last time they had sex but two years later, this number had fallen to 275 so overall, the number of men using condoms had fallen.

Another point the research raises is that 'the high frequency of coital injuries in uncircumcised men could place sex partners of HIV positive uncircumcised men at greater risk for HIV acquisition'. However, even if circumcision does protect men, there is no good evidence yet that it helps prevent transmission from HIV positive men to women. A trial in Uganda reported in The Lancet found that rates of transmission to women increased with circumcised men. The trial had to be abandoned for ethical reasons.

The research concludes that 'circumcision, condom use and penile hygiene provided protection against reported penile coital injuries. (...) The mechanisms by which circumcision confers protection against penile coital injuries remains unknown'.

It also states that 'recent circumcision did not increase penile coital injury risk' and this is about all that it can be said to have found. Condoms, reducing the number of partners, counselling and washing are all said to reduce injury but circumcision in itself has not been demonstrated to do so independently of these other factors. Too many variables.

Evidence against circumcision for HIV prevention and the risks involved here, here and here.

UPDATE: An interesting comment on this article from Lay Science:
The big drop in injuries for both groups after six months in the study is a sign of the Hawthorne Effect - just going in a study makes a difference. The difference between the two groups after that has been excluded is relatively small.

They don't seem to mention the commonest penile injury to intact men, torn frenulum ("banjo string"). This usually happens once in a lifetime, if at all. It is hardly surprising if having a sensitive moving part on one's penis might make it (slightly) more prone to injury. Circumcision as a way to reduce penile injuries is not indicated.

This is only the latest in a steady stream of papers originating from the same few researchers (Daniel Halperin, Robert Bailey, Ronald Gray, Stefan Bailis, Stephen Moses, Malcolm Potts, Thomas Quinn, Maria Wawer, Helen Weiss, Brian Morris, Jeffrey Klausner, Edgar Schoen and Thomas Wiswell - in this case, Bailey) claiming to show that circumcision is good for everything and harms nothing. I wouldn’t call it a “conspiracy”, but many of them have authored papers jointly, and their common interest seems to be in promoting circumcision, rather than any particular benefit.

Wednesday, 9 June 2010

Foetus Jesus

With only 199 shopping days left before Christmas, the churches have already planned their festive ad campaign, a scan of baby Jesus in the womb, complete with halo.

It was created by advertising executives from ChurchAds.net, a consortium of churches including the Church of England, Methodist, Baptist and United Reform churches, but not the Catholics. Some of Britain's top award winning ad execs and designers work for them for free.

Frances Goodwin of ChurchAds said: 'This is the kind of thing proud parents-to-be show their friends and family. Our poster reflects this new way of announcing the news of a new arrival and places the birth of Christ in an ultra-contemporary setting. It offers a fresh perspective on the birth of Christ - creating anticipation and alluding to both his humanity and divinity'.

And to his serious spookiness. Without the message at the bottom, this could easily be a poster for a horror movie. Come to think of it, it still could be.

The poster will be widely displayed, including at bus stops, which might not win it much approval from the parents of small children if they have to explain what it is and how a baby gets into the womb. They might also have to explain to more scientifically-minded children how a halo could show up in a scan where ultrasound bounces off solid objects. Smart kids may not be satisfied with the answer 'it's a miracle' and may wonder how Holy Mary feels about having a large hula hoop in her womb.

A more serious consequence of the campaign is that anti-abortion groups are seeing it as a great opportunity to spread their message. The director of the Society for the Protection of the Unborn Child said: "This advertisement sends a powerful message to everyone in Britain where 570 babies are killed every day in the womb, 365 days a year, under the Abortion Act. Whenever we kill an unborn child in an abortion, we are killing Jesus".

Killing Jesus - that's not at all emotive. And not that effective for non-believers and followers of other religions. SPUC can't even get their facts straight. The latest official figures from the Deparment of Health are 518 abortions a day. This may not make a huge difference but is symptomatic of their rather casual relationship with facts.

Terry Sanderson of the National Secular Society commented: "I hope that the Church of England isn't trying to use its Christmas poster campaign to make a political point. If that's the intention, we may have questions to ask at the Charity Commission".

Even if the churches are not deliberately using the posters to comment on abortion, they really should be aware of how groups like SPUC will hijack their campaign. After the first ever ad for an abortion advisory service on TV recently, pro-lifers will be looking for any way to hit back.

The posters won't go up until December 6th but will be available to buy online. A previous Christmas poster showed the Holy Family at a bus stop instead of in a stable and the 1999 Easter campaign had a really lame version of the Che Guevara poster.

Tuesday, 1 June 2010

Freak Parade

I've been looking for a new flatmate it's been a bit of an ordeal. In nearly 20 years of finding new flatmates on and off, I've never had this much trouble. There were a couple of really nice people who decided not to move in for financial or location reasons, some who just weren't right for the flat - or I wasn't right for them. And then there were the rest who rang, emailed and came round.

There were the ones who rang and whose sole word of English seemed to be FLAT. There was one couple who said they had a super cat even though the advert plainly said no couples and no pets. And the email from 'Two lovely Spanish girls and a rabbit'. Some people couldn't understand why I might want to know a bit about them before letting them into my home. One was a pastor and her email was full of God Blesses. Needless to say, she wasn't invited to visit.

Of the ones who came round, there was the nerdy guy who was about six foot eight. He sat on the sofa and stared straight ahead, not looking at me once. He did briefly liven up when we talked about graphic novels but struggled to be polite about my small collection. There was the man who was surprised I had anything intelligent to say about football. There was the Spanish artist who wanted to move because her current flatmate was 'a dirty man'. She was supposed to call me the next day and didn't. When I rang her, she said, 'I am working'. Silly me for interrupting an artist. I checked out her website and her work was pretty crap so she had nothing to be haughty about.

One guy in his early forties had been a Jehovah's Witness since childhood and just left. He sounded OK on the phone. When he came round, he stared at me the whole time like he was trying to hypnotise me. He insisted on taking his shoes off when he came in and had a hole in his sock with his big toe poking through which, in other people, wouldn't have mattered but it just added to his creepiness.

One young woman was so anorexic she looked like she'd snap if you slammed the door hard. I guess she wouldn't take up much space in the flat or hog the kitchen but I've done Flatmate With Issues and it's exhausting. Another one was scared of the lift.

There was the older Australian woman who didn't like the flat but wanted to meet me for a drink as she thought we could be friends. I have friends, thanks. I want a flatmate.

There were a few who turned their noses up at the lack of dishwasher or ensuite bathroom or my smallish TV. What do you expect for this money in central Camden?

Quite often, as soon as I opened the door, I knew they weren't the right person but still had to show them the flat and pretend to be interested in their lives. No doubt some of them felt the same about me.

I thought I'd have a look at the competition to see what other people were saying in their adverts. There was one on Gumtree from a middle aged man who was looking for a very young woman. The rent was just a few pounds a week, but she would be required to cook dinner, do the ironing and provide him with a daily massage. He said there was 'nothing funny' about it. I reported him to the admins anyway.

One woman who came to see the flat told me that she'd been to view another place and turned up early, so she rang the landlord. She'd spoken to him the day before but the number was now 'not available'. She got to the house and the front door was open, so she knocked and went in to find a lot of junk in the derelict-looking hallway and on the stairs. No one was around. She got to the door of the flat, which was also open. She then decided that she could well be in the opening scenes of a horror film and left.

I have a flatmate now, and he seems pretty normal. But then, so do I.