The Times doesn’t know Bayes

If you’ve spent any time at all reading science and medicine blogs, you know that many of us are quite critical of the way the traditional media covers science. The economics of the business allows for fewer and fewer dedicated science and medical journalists. In the blogosphere, writers have a certain freedom—-the freedom not to be paid, which means that the financial fortunes of our medium (the web) are not directly tied to how many readers I bring in with a headline. But all this is just a lot of words introducing my critique of a recent New York Times article.

The article is titled “Using Science to Sort Claims of Alternative Medicine”. It’s well-written and interesting, but suffers from a fatal flaw (or perhaps just recapitulates it)—like most of us, it fails to take into account how likely (or unlikely) a bizarre medical claim is when evaluating evidence for it.

The author doesn’t realize it, but he points out the fatal flaw in the modus operandi of the National Center for Complementary and Alternative Medicine (NCCAM). Lately, the alternative medicine community has seen some of its bigger trials fall apart.

The alternative medicine community has a few different sects. The largest is the group of various snake-oil salesmen out to make a buck on others’ suffering. Then there is the “supplement industry”. Finally there is the saddest sect—that of real scientists trying to use evidence-based medicine to evaluate improbable claims. These folks mean well, but they’ve picked the wrong tool for the job.

Continue reading “The Times doesn’t know Bayes”

The Times on Woo: Covering the Basics

The Times is running a series of articles today that cover the basics on woo, wooish thought, and one of my favorite subjects, pre-pure-food regulation impure food. Not much new here for Sciencebloggers, but these are good resources to help individuals think through the bogus claims we see so often in the marketing of woo.

William Broad discusses the National Center for Complementary and Alternative Medicine at NIH, which is charged with bringing better standards to situations like this:

…a 2004 Harvard study identified 181 research papers on yoga therapy reporting that it could be used to treat an impressive array of ailments — including asthma, heart disease, hypertension, depression, back pain, bronchitis, diabetes, cancer, arthritis, insomnia, lung disease and high blood pressure.

It turned out that only 40 percent of the studies used randomized controlled trials — the usual way of establishing reliable knowledge about whether a drug, diet or other intervention is really safe and effective…

But an enduring problem for higher-quality studies is the Frankie Avalon argument, discussed by Gina Kolada. Kolada explains that marketers can take advantage of years of headline-grabbing, smaller studies even where a large clinical trial disproves the efficacy of some treatment. Frankie Avalon apparently did this when a large trial showed that beta carotene was ineffective in preventing cancer:

When the bad news was released, he appeared in an infomercial. On one side of him was a huge stack of papers. At his other side were a few lonely pages. What are you going to believe, he asked, all these studies saying beta carotene works or these saying it doesn’t?

And of course, marketers of woo are always gaming the holes in the FDA’s jurisdiction. PalMD has written extensively on the Quack Miranda Warning. The new representation, covered by Gardiner Harris, is the “registered with the FDA” claim:

…the sellers of quasi-medical devices or food products that claim their products are “registered” with the F.D.A. may have done little more than send a letter to the agency. The Bioterror Act of 2002 requires food manufacturers to register with the F.D.A., but the agency almost never inspects these facilities or products.

Adding to this problem is the nutritional supplement situation. Although supplements look like drugs and are marketed in similar ways, Harris explains that, “the F.D.A. does almost nothing to ensure that dietary supplements work as advertised. Only when supplements are proved to be unsafe or to contain regulated substances can the agency take action.”

* * *

And on to pure food.

“…it’s worth remembering that it has been far worse. China’s present is America’s past,” argues Bee Wilson in an article discussing the Swill Milk Scandal in New York City during the 1850s.

This one is really worth a read, even if you’re familiar with the more general topics covered above. The past is a grotesque animal:

In a city growing fast, but lacking refrigeration, it was hard to provide sufficient milk. Fresh milk was brought in from Westchester and Orange Counties, but not enough to meet demand. In 1853, it was found that 90,000 or so quarts of cow’s milk entered the city each day, but that number mysteriously increased to 120,000 quarts at the point of delivery.

Some of the increase was due to New York dairymen padding their milk with water, and then restoring its richness with flour — just like their latter-day Chinese counterparts, who increased the protein levels in watered-down milk by adding the noxious chemical melamine. But the greater part was swill milk, a filthy, bluish substance milked from cows tied up in crowded stables adjoining city distilleries and fed the hot alcoholic mash left from making whiskey. This too was doctored — with plaster of Paris to take away the blueness, starch and eggs to thicken it and molasses to give it the buttercup hue of honest Orange County milk. This newspaper attributed the deaths of up to 8,000 children a year to this vile fluid.

Profiting from others’ suffering—the difference between skeptical doctors and crooks

Morgellons “disease” is not a disease in any classic sense. There are no agreed-upon definitions of a case, so all else is meaningless. That being said, people are suffering. Since they feel ignored by doctors, they seek help elsewhere.

It’s a problem in thinking, in some ways. When you don’t feel well, you should seek help from a professional and see what they think, rather than have a fixed idea of what’s wrong, and find a professional to confirm it. Otherwise, we wouldn’t need professionals. I could simply call my chest pain “Pal’s chest pain syndrome”, and, no matter what the doctors say, tell them they don’t get it.

Part of the problem is a natural consequence of medical practice. As physicians, we look for patterns. Yes, we care about individuals, but each patient also represents an example of particular diseases. This is how we end up with shorthand like “the MI in 6312”—it ignores certain details about the individual in favor of the pattern of their disease. When talking to a patient, she may be Mrs. Z., but when using the shorthand of medicine, she’s a classic MI, and needs a particular treatment based on medical evidence.

Some people are perhaps more sensitive to this depersonalization; others have personalities that are intolerant of believing they could be wrong. I’ll leave it to the psychiatrists.

What I can’t leave to the shrinks is the patient in my exam room. If she believes she has Morgellons, there isn’t all that much I will be able to do to relieve her suffering, because I won’t lie to her.

I have many patients with abdominal pain that has no known cause, and has never resulted in injury, but the patient is miserable. There are a lot of non-placebo remedies I can try to make them feel better. I don’t deny their pain—it’s real. I honestly tell them I don’t know the cause, but I’ll keep trying to make them feel better.

With problems like Morgellons, this approach is useless. Patients don’t just complain of discomfort—they know what is wrong, and nothing will dissuade them. Since I won’t lie to a patient, I can only tell them that I know they don’t feel well, and I’ll try to help them feel better—but I cannot allow them to think I buy in to their false interpretation of their symptoms.

But others will be happy to oblige them. For example, despite the absence of evidence that chronic fatigue syndrome is a viral illness, or that it responds to anti-viral therapy, there are doctors who are very compassionate and will treat you for your “viral problem”. The patients don’t get better from the treatment, but they occasionally get better spontaneously. More importantly, they have found someone who listens and believes them—which is too bad, because it’s all non-scientific bullshit, and costs a ton of cash.

Getting back to Morgellons, there are many who would, in direct contradistinction to a real doctor, profit off the fears of others. For example, one website, along with a Quack Miranda Warning, offers costly treatments for “ectoparasites”. The offer doesn’t say so, but implies that Morgellons sufferers should use their product. In the usual crooked fashion, they sell potions to cure parasites, but then say that, “These products are not sold as pediculicide nor scabicide.”

FDA! Were are you?!?

Having a mysterious ailment that people don’t believe in is problem enough. But you should be happy your doctor tells you the truth, rather than trying to fleece you. In this instance, good doctors know better than to feed delusions. It helps no one. Unfortunately, others are happy to feed delusions just to see how much money folks will cough up. They should be ashamed.

But of course, they have no shame.

Were the ancients fools?

I’m off to the west coast (of Michigan) for a few days, and if I don’t blog, I shall die…or something. So I have a few posts from my old blog to share with you.

Often in the discussion of cult medicines such as homeopathy, acupuncture, and reiki, supporters fall back on “the wisdom of the ancients”. This raises a question. Since “the ancients” had it wrong (i.e. their belief systems could not effectively treat disease), were they just stupid?

Any of my historian readers already know the answer, but it’s worth going over…

Our forebears were neither more nor less intelligent that we (unless you go back about 3 or 4 million years—that gets rather dicey). They were literate, intelligent, and damn good thinkers. They just had limits to their ability to investigate their environments.

Let’s take an example. This is from an English physician living in Paris in the mid-18th century, during the time inoculation against smallpox was spreading, but vaccination had not yet been invented.


By way of background, this new (to Europe) practice actually comprised many different practices, but the basics were the same: take a bit of material from a smallpox pustule, and rub, snort, or inject it into the skin of a healthy person. The healthy person would then (hopefully), develop a mild case of smallpox that would protect them from epidemic smallpox, which had a high rate of mortality and disfigurement.

Dr. Cantwell, an English physician in Paris, had some concerns about this procedure (translation unfortunately mine):

It is facts, and not the promise of them, and reason, that must truly interest the public. If they respond to the promises of the Inoculators, inoculation will establish itself despite all that can be said to show the danger and inutility of it. If, on the contrary, the facts directly dispute their promises, the public will be disabused and inoculation fall by the wayside.

As for my part, I would say that if among the Inoculators there is found even one who responds pertinently to the facts which I allege, I will be the first to swear to my defeat, and will side with these gentlemen. If not, justice demands that one always allow that new facts could be gathered against this method, and they must be rendered public with all pertinent arguments.

It is not enough to say that of one hundred persons inoculated, only one or two perished in the first forty days. It is a question of knowing FIRST if Inoculation gives lifelong protection from smallpox, and if one can be killed by a natural smallpox infection which may follow the artificial one…. SECOND it is necessary to know, again, if inoculation might accidentally spread smallpox, in the right conditions causing more people to perish of this contagion than would be saved by its application…(emphasis mine)

Dr. Cantwell was basically one of the earliest opponents of immunoprophylaxis (prevention of disease via inoculation or vaccine). Was he a crank?

Well, not by this excerpt. He asks the same questions that we do today regarding a vaccine: what is the mortality from the procedure, does it actually protect, and could it possibly spread disease.

This is very “modern” thinking. It turns out that Dr. Cantwell was both right and wrong in his apprehension about inoculation. There were, of course, no standard practices, and people were hurt, but in general, it tended to save lives during epidemics.

Thankfully, the much safer practice of vaccination came along, largely building on the knowledge of inoculation, and the discovery of healthy milk maids. (What was Jenner doing hanging out with the milk maids?)

So, the ancients did indeed possess wisdom; they just didn’t have all the tools to apply it, including statistics, microbiology, and a well-developed germ theory of disease.

It would be wise to remember that our forebears, though smart, didn’t have the tools we have today. To rely on their intelligence but eschew modern knowledge makes us look like the fools.

I Love the French

Why? Well, among other things, for hating billboards. Max Colchester of the Wall Street Journal reports:

On Friday, Alex Baret plans to board a train to central Paris, pull out a can of spray paint and deface a billboard, as he has done every last Friday of the month for more than two years. The slogan he prefers to leave scrawled on his targets: Harcèlement Publicitaire, or Harassment by Advertising.

How did this hate for billboards come about, you ask?

Mr. Baret says the seeds for his campaign were sewn in the spring of 1997, when he was riding the Paris subway and he looked up at an ad. “I suddenly thought: ‘I am in a prison,’ ” he says. “I saw the slogan, the lies, and it disgusted me.”

The average guy on the Paris subway is a critical theorist! Awesome!

Just imagine how Clear Channel would respond to this…they’d probably release the hounds! And what is the French industry’s response? Well, it’s French!

The industry is remaining stoic. “There is no point rolling around on the floor crying,” says Stephané Dottelonde, president of the French Union for Outdoor Advertising. “You have to respect that these groups exist.”

The Business of Green

I had the opportunity to see Felicity Barringer, the New York Times correspondent, speak on the “The Dangers of Environmental Parables” at University of Wyoming’s Consumer Issues Conference. Barringer argued that simple parables, such as the greed-versus-good stories present in the seminal Silent Spring no longer capture the complex landscape of environmental issues presented today. She offered the example of the potential for wind power in the Alleghenies, which is opposed by an environmental NIMBY activist named Dan Boone who thinks that the broader environmental movement has perverse priorities. It’s no longer a matter of cutting corners to save money, environmental battles now involve complex choices. Is clean power more or less important than saving a beautiful landscape, birds, and bats from wind turbines?

Barringer is probably right about most environmental battles. But some still fit the old parables. I would argue that the speeding Chinese poison train, which this week features the addition of melamine to consumer products, is an example of the old style greed-versus-good parable. Melamine is being added to these products in order to make them appear to be more nutritious. This is not an accident or some complex decision concerning risk tolerance.

Barringer also discussed how the future of the green movement will be tied to making a business case for environmentalism. I think there is a lot of truth to this too, but I remain skeptical of business attempts to sell us on “green” items. So many products advertised as green have dubious credibility, but there are good resources to help sort things out.

My favorite example of a “green” option is the reusable shopping bag. Ellen Gamerman reports in the Wall Street Journal:

It’s manufactured in China, shipped thousands of miles overseas, made with plastic and could take years to decompose. It’s also the hot “green” giveaway of the moment: the reusable shopping bag.

It’s not all bad. Those reusable bags can save energy, if you reuse them. Otherwise, they take more resources to create, and to me, are another example of how we are manipulated into thinking that we are acting in a socially responsible manner. Back to Gamerman:

Finding a truly green bag is challenging. Plastic totes may be more eco-friendly to manufacture than ones made from cotton or canvas, which can require large amounts of water and energy to produce and may contain harsh chemical dyes. Paper bags, meanwhile, require the destruction of millions of trees and are made in factories that contribute to air and water pollution.


Some, such as the ones sold in Gristedes stores in New York that are printed with the slogan “I used to be a plastic bag,” are misleading. Those bags are also made in China from nonwoven polypropylene and have no recycled content. Stanley Joffe, president of Earthwise Bag Co., the Commerce, Calif., company that designed the bags, says the slogan is meant to point out that the bag itself is reusable, taking the place of a disposable plastic bag.

And what’s the business case for going green here?

[Stanford marketing professor Baba] Shiv…says that according to surveys done by his graduate students, many shoppers say they are less likely to carry a retailer’s branded reusable bag into a competing store. “What these bags are doing is increasing loyalty to the store,” he says.

Immune to reality

I’m off to the west coast (of Michigan) for a few days, and if I don’t blog, I shall die…or something. So I have a few posts from my old blog to share with you.

Sure, we all have our biases about food and health. I think chicken soup is great when you’re sick—but not because of any proven biologic benefit. It just tastes and feels good, which is about the best you can expect in treating a cold.

But food claims are becoming more and more fanciful. There is a lot we do and don’t know about nutrition. Many of these fanciful claims seem to be centered on “immunity”. This is a word beloved of cult medicine. Cultists like to speak of various things “boosting immunity”, “enhancing immunity”, etc.

They have no idea what they are talking about…

Immunology was my favorite subject in medical school. The immune system is incredibly complex and fascinating. People tend to think about it as fighting off disease, but it’s activities are far more intricate. Immune responses can fight disease, or can kill you. It is so complex, that the terms “overactive” and “underactive” are essentially meaningless. Someone can have an auto-immune illness like multiple sclerosis, in which the immune system destroys certain parts of the nervous system, and at the same time be more susceptible to certain diseases. There is no “volume” switch, as such.

Much of this is because immunity has both specific and non-specific responses available to it. The immune system can recognize the antigens on a Staphylococcus bacterium causing a skin infection, and send troops in to kill it. Or, you can develop an inappropriate and overwhelming immune response known as “sepsis” and die.

Cultists tend to have a reductionist approach to their sales pitch. Something either “enhances” or “calms” the immune system, whatever that means.

Actually, one of my favorite statements comes from our buddy Gary Null’s website.

There are two things about the immune system which everyone has had instilled upon them and which we all now accept. Firstly, your immune system is directly related to your genitals which are completely separate to the rest of your body, as witnessed by the birth of genitourinary clinics attached to every hospital. It has also been given to us as a fact that you can tell what state your immune system is in by counting the number of T-cells that you have in any given millilitre of blood and monitoring them closely.

The whole “genital” thing just kills me. I actually did a spit-take with my coffee. The article actually goes on and on in a non-sensical fashion for a while. But maybe this immune thing is just some fringe idea.

No such luck. Just open a magazine or newspaper, and adds abound for “immune boosters”. But the cultists have a special role here—they supply the pseudoscience behind the adds. For example uber-crank Joe Mercola has a shocking article that combines a fundamental misunderstanding about both the immune system and vaccines.

Vaccines, all vaccines, are immune suppressing; that is they depress our immune functions. The chemicals in the vaccines depress our immune system; the virus present depresses immune function, and the foreign DNA/RNA from animal tissues depresses immunity. Toraldo, et al found that the chemotaxis and metabolic function of PMNs (polymorphonuclear neutrophils) was significantly reduced after vaccinations were given and did not return to normal for months. Other indicators of immune system depression included reduced lymphocyte viability, neutrophil hyper-segmentation, and a reduced white cell count. All vaccines are immune depressing to some extent and that is the trade-off we are risking. The medical thought is that we trade a small immune depression for an immunity to one disease. Now let me repeat, we are trading a total immune system depression (our only defense against all known disease – including millions of pathogens) for a temporary immunity against one disease, usually an innocuous childhood disease. Therefore, the trade is not at all fair. Mullins puts it this way, “Are we trading mumps and measles for cancer and AIDS.”

Wow. Pure. Unmitigated. Bullshit. This shows a complete lack of understanding about what immunity is, and contains anti-vaccine nuttery to boot. Let me show you a little bit more.

Vaccines suppress our immunity merely buy over-taxing our immune system with foreign material, heavy metals, pathogens and viruses. The heavy metals slow down our immune system, while the viruses set up shop to grow and divide. It is like being chained and handcuffed before swimming.

I thought he said vaccines suppressed the immune system. There is no science behind any of these assertions.

Vaccines clog our lymphatic system and lymph nodes with large protein molecules which have not been adequately broken down by our digestive processes, since vaccines by pass digestion with injections. This is why vaccines are linked to allergies, because they contain large proteins which as circulating immune complexes (CICs) or “klinkers” which cause our body to become allergic.

Really, this guy has never read an immunology text book. Our immune system is not some series of “tubes” that can “clog.”

Vaccines deplete our body of vital immune-enhancing nutrients, like vitamin C, A and zinc, which are needed for a strong immune system. It is nutrients like these that primes our immune system, feeds the white blood cells and macrophages and allows them to function optimally.

And it’s back to the nutition/immunity woo. None of these statements has any basis in science.

So what? What’s the harm?

The harm is that because he is a “Dr.” and uses big words, people will believe him. They will avoid real health measures, such as vaccines. Just to ramp up the scare tactics, he actually links vaccines to AIDS.

This is probably the worst article I’ve seen from Mercola’s website. It’s downright dangerous.

But his view is the extreme. “Mainstream” folks are selling nutritional advice for “immunity” everywhere. None of it has any scientific evidence. None of the merchants even knows an immune system from a tie rod.

There’s nothing wrong with eating right. It can help prevent and treat diabetes and hypertension. Usually, fewer calories is the key. There are proven diets, such as DASH, and nutritionists are a key member of a diabetes treatment team. Unless they are selling something.

False equality

I’m off to the west coast (of Michigan) for a few days, and if I don’t blog, I shall die…or something. So I have a few posts from my old blog to share with you.

As my child approaches school age, I worry about school board battles a little bit more. I hate politics, but I can see myself forced to get involved at some point. And I find myself wondering, what is it about some Evangelical Christians? Why is their faith so weak? Is God testing them? I ask this because of their constant griping about “equal time” for Creationism in public schools. Given that science classes are supposed to teach science and not religion, it’s pretty much a no-brainer; and after the smack-down they received in Dover, you’d think maybe, just maybe, they would have learned their lesson. But these soldiers for Christ carry on, betraying their ultimate lack of faith in the Bible and their God.

Lack of faith? But they’re fighting so hard for their faith! Whatever could you mean?

Faith, which is the belief in the supernatural despite lack of evidence, is, in the terms of some theologies, a gift from God. It is the belief in things not seen. It’s essentially a test—believe in Me despite my refusal to prove my existence, and you will be rewarded. Anyone can believe in a God who walks the Earth. It takes a special kind of believer to follow a God who never shows up.

Most of the truly faithful go about their lives with their belief, understanding that God is not likely to confirm their faith until they die. And that’s just fine with them, because it doesn’t change most of the events of the day. The sun rises, the sun sets. The car starts. The snow falls. These things happen for the faithful and heathen alike.

But the ID’ers out there seem to lack a strong faith in their God. They feel that scientists, teachers, and governments must give them a stamp of legitimacy. Their faith is so weak that a high school biology teacher can shake its very foundations.

Want to prove your faith in God? Then live among those who don’t believe, and let that reinforce your ideas. Move to Israel, to Iran, to Saudi Arabia for a year and let your faith be tested. But stop saying that your faith deserves equal time along side science in classrooms. The idea is insulting to those of us who don’t share your beliefs, and should be insulting to you, as it implies that you need your God to have the approval of secular authorities.

I bring this up because of a concern that, admittedly, is a variation on a slippery slope argument. If you can insert Creationism into a science classroom in the name of “equal time”, then you could also put homeopathy and other cult beliefs into medical schools for the same reason. This, despite lack of any scientific evidence.

The attack on science isn’t limited to the overtly religious, but as I’ve said before, many of these altmed beliefs are essentially religion, in that they require faith over reason.

So teach your kids whatever you want. Just don’t teach it to mine.