Thursday, 29 July 2010

Does the Government Actually Do Good, or Just Create the Feeling It Does?

The Government response to the House of Commons Science and Technology Committee report on Homeopathy has been published, and is a masterpiece of dodging the issue. Congratulations to the author, Sir Humphrey Appleby.

In short, they refuse to stop NHS funding of homeopathy, preferring to abdicate responsibility to the PCTs; see here:
(Committee conclusion)
By providing homeopathy on the NHS and allowing MHRA licensing of products which subsequently appear on pharmacy shelves, the Government runs the risk of endorsing homeopathy as an efficacious system of medicine. To maintain patient trust, choice and safety, the Government should not endorse the use of placebo treatments, including homeopathy. Homeopathy should not be funded on the NHS and the MHRA should stop licensing homeopathic products. (Paragraph 157)
(Government response)
We note the Committee’s view that allowing for the provision of homeopathy may risk seeming to endorse it, and we will keep the position under review. However, we do not believe that this risk amounts to a risk to patient trust, choice or safety, nor do we believe that the risk is significant enough for the Department to take the unusual step of removing PCTs’ flexibility to make their own decisions. We believe that providing appropriate information for commissioners, clinicians and the public, and ensuring a strong ethical code for clinicians, remain the most effective ways to ensure quality outcomes, patient satisfaction and the appropriate use of NHS funding.
They do say something about placebo. In response to the Committee's observation that:
We would expect the Government to have a proper understanding of the power and complexities of the placebo effect and the ethical issues surrounding its use in a clinical setting; otherwise it cannot hope to make good decisions relating to patients and public health.
...the Government says:
The Government agrees that, when looking at the evidence base for efficacy, it is important to focus on the most scientifically robust studies and evidence. We note, however, that a “proper understanding of the power and complexities of the placebo effect” is difficult to achieve, since we are not aware of any scientific consensus at present on the mechanisms by which placebos have an effect. We note also that it is not for the Department of Health to comment on the ethics of the use of a particular treatment in a particular setting. 
So they've decided that the Government should have no ethical view on placebo use.

The difficulty is obvious. The way is open for any number of placebo effect treatments to be given Government funding; how could they be stopped, if patients are demanding them and saying that they feel better thanks to them?

As Steven Novella points out:
...for any objective outcome, there is no important placebo effect. For outcomes that are subjectively reported by patients, there is a highly variable placebo effect. It is plausible that the expectation of benefit could result in the release of dopamine and endorphins and produce a physiological decrease in pain, for example, in a subset of people, and there is some evidence for this. But this is, at best, a transient symptomatic effect – not therapeutic.
Such effects are also non-specific – meaning they do not derive from the intervention itself, but from the therapeutic ritual surrounding the intervention. Even treatments that do not work may therefore provide these non-specific benefit. My opinion is that the non-specific benefits of the ritual of treatment should be combined with an actually effective treatment, not magic pretending to be medicine.
Or, if no actual treatment is available, any placebo should be delivered for the minimum cost. That would certainly exclude comparatively complicated treatments such as homeopathy and acupuncture.

The major problem with such Government indecision is the patina of respectability it gives these purveyors of *nothing*; they are free to pretend they are being efficacious, and this adds to the totality of woo in this supposedly civilised society. The more woo we can eliminate the better informed our citizens will be, and the more likely they are to lead healthy lives, in my opinion.

Further, a Government that condones treatments that just make people *feel* better, rather than *actually* better, might be tempted to extend that principle to other policy areas; would they prefer policies that work, or policies that make people think they work?

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Thursday, 15 July 2010

Shit hits Fan

Jack of Kent has blogged about an amusing sequence of events on Twitter yesterday, starting when @GillianMcKeith responded impetuously to a Goldacre fan; go there for an amusing tale that casts light on modern manners in the internet age.

The encouraging thing is the way that, in an electronic age, evidence can be uncovered which details someone's potentially nefarious activities - and it's nigh on impossible to cover those tracks.

The worrying thing is the way that, in an electronic age, evidence can be uncovered which details someone's innocent, but private, activities - and it's nigh on impossible to protect one's privacy.

There are various tools available to make one's online presence less traceable, but that becomes moot when one is commenting in person. Incidentally, although it's not clear that Gillian McKeith made the comments on the Twitter account above, it's clear that it has been held out as an official Twitter for her, with links from her official website, and surely a reasonable person must conclude that her organisation is at least responsible. Although, perhaps the website is an elaborate hoax of which she is unaware too!

UPDATE: Ben Goldacre has blogged about it now.

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Saturday, 10 July 2010

The Irony is Palpable

As I explained in my last blog, there is a curious strain of atheist or agnostic who, when perusing public discourse on matters of import, decides that the greatest enemies to improved reason and progress in that public discourse is something called a new atheist. It's difficult to define, but you know one when you see one! Meanness and snark is supposedly their defining attribute, according to those atheists who deplore them.

The facts, as we have seen, rather go against this attribute being a defining one, since these atheists, who deplore meanness and snark in public discourse, also employ it. Remarkably, their response to these revelations of meanness and snark by their own sympathisers, is to engage in yet more meanness and snark; here is an example, from Jeremy Stangroom, a respected writer and sociologist.

Remember, to put this into context, new atheists, such as PZ Myers, Jerry Coyne and Ophelia Benson, have had their reputations besmirched by a sock-puppet posing as a scientist claiming that some new atheist acolytes behaved rather boorishly in the faces of a theist or two (the story is a little vague); this was elevated by Chris Mooney at The Intersection into its own blog entry, presumably in support of Mooney's position, that the new atheists are mean and snarky (which isn't really in doubt), and that this is counter-productive to public discourse (which is). Now the story has been shown to be an invention, new atheists are pointing out the hypocrisy of the self-righteous brigade. Apparently, that is not allowed, according to Stangroom:
Basically, there’s this fella called Chris Mooney, and he tortures kittens. Not literal kittens, but metaphorical kittens that have something to do with framing and accommodation and communion wafers. Anyway, torturing kittens is a bad thing, especially if you get paid by the Templeton Foundation to do it, and this really, really, really upsets those righteous defenders of all that is good and true – the New Atheists.
The irony is palpable. The point here is that new atheists don't mind torturing kittens (er, metaphorically), it's that Mooney doesn't like it, and denounces it in others, but still does it himself. It's the hypocrisy that is the problem.
Now the New Atheists go on about Chris Mooney a lot. Imagine Sisyphus being condemned to listen to some facile bit of Vivaldi for the whole of eternity, or maybe Brian Leiter listing all the people he thinks don’t understand Nietzsche, and you’ll get a sense of it.
The irony is palpable. The point here is that Mooney goes on about the new atheists; he wrote a book which included attacks on them. They couldn't have cared less about him otherwise.
The vindictiveness and viciousness of the New Atheist horde in the face of Tom’s misbehaviour is extraordinary.
The irony is palpable. The point here is that the new atheists have been the subject of reputation-tarnishing untrue slurs from a chap who is hiding behind a pseudonym; it takes a great leap of logic to equate that sort of genuine vindictiveness and viciousness with questions seeking to understand the nature of Mooney's investigation of Tom's misbehaviour.
(To which, if I were Jean, I would be tempted to reply Fuck Off.)
The irony is palpable. Yay for less meanness and snark in public discourse!
Anyway, what’s amusing about all this is that it’s exactly the sort of reaction one would expect from certain sorts of religious fundamentalists when confronted with behaviour they consider unconscionable. It’s a demand for justice and retribution born of an absolute certainty of moral righteousness.
The irony is palpable. And posing as a scientist to deliver a self-serving lie is exactly the sort of reaction one can expect from self-righteous atheists posing as morally superior? Yeah, right.
However, the truth is the participants in this witch-hunt are the 21st century, virtual-world, equivalent of a medieval mob baying for the blood their latest victim.
The irony is palpable. And attacking people standing up for reason and evidence against the unreasonable and deluded rather than attacking the unreasonable and deluded is not medieval in the least, is it?

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