Today I saw one that I just had to have some fun with and hopefully give people some idea of what the product is really about at the same time.

In this case the product was an “Energy Calcium Activation Cup”. I hadn’t heard of these before but the altmed buzzword combo of “energy” and “activation” got my attention.

The forum moderators tend to be quick to remove questions about products that are overtly critical so I had to play a bit dumb and make sure I didn’t get too much to the point. The outcome was quite amusing:

You can see the discussion at:
http://www.grabonestore.co.nz/energy-calcium-activation-cup/discuss (or archived at  http://www.webcitation.org/6GTWgpSot just in case the entire thing gets deleted after this post goes live)

I would like to thank the company liaison Sabina Chadliwa who here was very forthcoming and quite speedy in comparison with other companies I have interacted with in this way. No offense is meant to her – but BS is BS.

In any case most shows do poorly at portraying science, this comes inevitably out of the fact that the show is there to tell a story. The science may or may not help with that but in the end it is merely set dressing for the real aim. I’m fine with that – I watch a lot of tv and aside for the odd grumble along the lines of “It would take longer than that!” or “You wouldn’t do it that way!” I’m happy enough to suspend my criticism and enjoy the ride.

But the question remains – which show does it best? Over the weekend an answer came to me that might be cheating a bit, but I think the best I’ve seen lately is one called “Guess with Jess“*.

If it sounds like a kids show, you’re right – it is.

The basic set up is like this: A cat decides on a question for the day and then sets about trying to answer it. Pretty simple.

I think it does pretty well showing the methods of science:
A question is generated via an observation of the world, a “literature” search is conducted to find what is already known on the topic (via asking the other animals), a hypothesis is generated that fits the question and what is known, the hypothesis is tested and the results observed to see if it answers the question. Often the first attempt is incorrect, so the question is refined, another “literature” search is conducted, another hypothesis generated and another round of testing conducted.

At the end an answer is arrived at which satisfies our feline protagonist and everyone is happy at having learned something new. Possibly Jess goes off to write a grant proposal – I’m not sure.

So that’s my answer. Adult fiction is too focused on telling a compelling story with relate-able characters in a limited time frame to make more than a passing effort at getting the science right. But that’s ok, we can rely on a young cat named Jess to pick up the slack.

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* If a black and white cat named Jess sounds familiar, you might remember that this describes the cat of Postman Pat. According to wikipedia they are one in the same, I’m not sure if Jess has been put out to pasture or if this depicts Jess’s life before settling down with Pat.

Some updates: I’ve added some demographic questions so if you have already filled out the quiz you can do it again to fill out the new data set! YAY!

Questions look at age, education level – that sort of stuff.

Anyway what have we found so far?

Average score is 24 with 68% of respondents being within +/- 3 points of this value (1 standard deviation for those who remember such things). The lowest score 4. A mere 7 respondents scored lower than 15. Almost 380 people got 20 or higher

With each subcategory of the test being so small (5 questions or less) and with so many people getting greater than 20 these are pretty difficult to interpret – so I won’t.

If anyone wants the full data set I’m happy to provide it, it’ll only get better and more interesting with those demographic questions added, so take it again – really – that would be cool. And pass it around especially if you have colleagues, family and friends that are outside of the science arena!

Here’s the link again. Enjoy, it’s fun – honest.

Thought I’d put up a couple of initial thoughts/feed-back on the testing:

First off it’s becoming clear that some of the questions are ambiguously worded. This is especially obvious in the results for questions 12 and 14.

Question 12, looking at categorizing sources, is worded in such a way that it is not clear whether the question refers to the story extract itself or the sources used in the story extract. This means that respondents incorrectly label the source as “Primary” (correct for the sources used for the story extract) and “Tertiary” (correct for the story extract itself and therefore the correct answer for the question).

The other one that people are obviously getting wrong because of the wording (including myself) is question 14. This question asks what element of a study design is not a strength of the study.

This implies that you are to critique the design as it is actually presented, not how it could have been. Thus people are choosing the option that is “least wrong”. A bit of a change in this wording to make it clear what design could have been used but wasn’t or that could have made the study better or even restricting the answer options to just the study elements present in the background information would probably bring the score for this question up.

Interestingly there are a few questions nobody has gotten wrong, indicating they may be a little too easy (but perhaps the sample size is still too small yet, 45 responders so far).

The first question “Which of the following is a valid scientific argument?” has a 100% responder correctness score. As does Question 16 on the proportions of house building materials and question 20 on the rat population. Question 27 “Which of the following actions is a valid scientific course of action?” also has a 100% score.

So, great stuff so far, as I mentioned there’s been about 45 people taking part so far and things already are shaping up nicely. So spread the word and lets see how many people we can get. If possible it would be nice to get constructive criticism on the question wording like I have done above that can be feed back to the original test designers.

Thanks for the interest so far and keep it up!

I liked this idea so much I decided to put together an online version of the quiz that people could take and get instant feedback for. This could also be adapted for use in an educational environment as intended in the original paper.

To that end I need beta testers, people who would like to take the test and give me feed-back on how to improve it. A couple of things I need to mention at this point:
First, the test will ask for your email address in order to send a summary of how well you did on the test. Your email address will not be used for any other purpose and indeed I’ve set up the back-end so that the address will be deleted as soon as your email is sent – your private information will remain that way.
With this in mind – If you have feed-back about your performance, there is no way for me to tell which entry is yours unless you give me the time you submitted the form.

Secondly, I have used some custom html code in creating the form which doesn’t integrate seamlessly with the google drive document that runs most of the functionality. This means if you miss a required question (all of them are required FYI) than you will be re-directed to the original form of the test, this will look a bit different and will not contain the pictures (but will have urls you can use to get to them).
You can either continue with this version of the form or hit your browser’s Back button and fill out the questions you missed there.

Finally, If you have and comments or suggestions leave them here and I’ll see what I can do. Also I am actually fairly mediocre at html coding and such like so if there is anyone who wants to volunteer their services to upgrade the quiz I’m happy to share the load .

Ok, here’s the link to get you started, have fun.

[Edit: Here's a link to some initial analysis of the results]

This indeed was my main goal. There are innumerable groups out there that I don’t agree with but you get that in a wide and varied world. In the case of the IAS though the speech they engage is is effectively publicly subsidised via the tax exemption, this should mean that they are constrained in what they can say. At the very least it should mean that they must present the facts undistorted by ideology.

Yesterday I found out that the Charities Commission agrees with me. In a decision handed down late last month they determined that the IAS does not qualify for charitable status and removed them from the charities register.

So, I guess you could say – I won.

It the words of one of my colleagues it also shows that one person can make a difference. Clichéd but true.

Reading through the Charities Commission decision it seems they focused on two things:

1. The biased nature of the information provided by the IAS and;

2. The political nature of their campaigning for a change in public policy.

This makes sense given the requirements that the Commission need to fulfil to determine whether an organisation meets the requirements to be a charity. Even so I’m a bit disappointed that there was no focus on the factual inaccuracy of and misrepresentation in the materials published by the IAS.

The decision does seem to skirt this line though when stating that  “Overwhelmingly, the information on the website argues that vaccination is ineffective and dangerous” the inference being that is view is incorrect as well as being biased. Even so, none of the language of the report actually states this outright (that I can see).

There was also an additional point touched on that merely providing information does not in and of itself “advance education”. In other words to be an educational charity you actually have to actively educate people, not simply act as a repository of information – otherwise every private citizen with a decent library or informational website could become a charity.

Finally, in my personal 15 minutes of fame, the Commissions decision has been reported in the Dominion Post – complete with a quote from me. Not my most eloquent moment but it’s close enough to the point I wanted to make that I’m fairly happy.

[Edit: Thanks goes to commenter Hemlock for sharing the IAS response to this news]

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1.  And here they are in all their tedious glory:
http://scepticon.wordpress.com/2011/10/11/anti-vaccine-charities-is-there-any-quality-control-on-charities/

http://scepticon.wordpress.com/2011/10/11/ias-complaint-part-1-thimerosal-in-your-vaccine-no/

http://scepticon.wordpress.com/2011/10/12/ias-complaint-part-2-gardasil-horrors-horrific-reasoning/

http://scepticon.wordpress.com/2011/10/13/ias-complaint-part-3-vaccine-ingredients-not-so-bad-really/

http://scepticon.wordpress.com/2011/10/14/ias-complaint-part-4-anti-vaccine-impact-in-new-zealand/

http://scepticon.wordpress.com/2011/10/17/defending-the-term-anti-vaccine/

http://scepticon.wordpress.com/2011/10/18/the-legitimate-risks-of-vaccines/

In setting up how “everyman” their acquisition of the new phone was the author provided a teaching moment on the ins and outs of investment bias and how we prefer things when they are hard to get.

Here’s the extract of relevance:

“Just to be clear, this isn’t some corporate review unit we’re talking about—we waited outside at the hellacious crack of dawn in a hell-pit shopping mall alongside people who were willing to actually hit each other for a new phone. We battled line-cutters and a shifty AT&T retail manager. I wasn’t due for a new contract, so I ponied up extra money for a semi-subsidized handset I was truthfully only buying because I shattered my last one.

I say this both because we got this phone like most people did, and because it was a gigantic pain in the ass. I had every reason to resent the iPhone 5. And yet…”

This might be intuitive but actually gets the psychology precisely backwards. We actually value things more highly if we are force to go through hardship to get them.

A similar effect is seen with the (now illegal) “hazing” rituals of American college fraternities. These groups would put new recruits through torturous initiation rites. You would think that any normal person would despise with a passion the person or group that did this to them but that’s not the case; these rituals inculcate a fierce loyalty to the group.

One theory to explain this is that of Cognitive Dissonance, the reasoning goes that people are justifying the effort by convincing themselves that they really like the group/item/task that they had to go through so much pain to join/get/complete because otherwise they are some sort of moron. Ok maybe not quite in those terms, but you get the idea.

To illustrate this from a slightly different perspective here’s the defining early experiment demonstrating the effect. Participants in the study had to complete an extremely boring task (adding and removing spools from a tray and turning pegs for about an hour). They were then paid to lie to a new participant about how enjoyable the task was, for this they were pain either 1$ or $20.

After this the participants rated honestly how enjoyable they found the task.

Those who were paid $20 predictably rated the task as boring, but those paid only $1 rated it as relatively more enjoyable.

These participants had done something relatively distasteful (lying) for very small reward ($1), as such they had two choices consider themselves liars or alter their attitudes about the task to seem like they hadn’t really lied at all. Being the heroes of their own story, as we all are, they “chose” the second option.

How does this relate to the hardship of getting an iPhone on release day? Well, if you go through all that effort you are either a schmuck, or the product really is that good. I know which one I’d rather believe.

That’s not to say the phone isn’t that good, could be. But it is one more thing to cement loyalty to the brand. Maybe other brands should take note.

I think the author of this article is quite correct in his condemnation of this person and those who support him who tout this technology as a solution to the country’s energy woes. That said I think he does his audience a disservice in not breaking down the claims more fully to explain why this “invention” is not all that it seems and why it will not act as a panacea for the dependence on fossil fuels and the deficit of energy that Pakistan endures.*

It is explained that you cannot run a car on water due to the fact that that it would require a reversal of the second law of thermodynamics. A law that is deemed so fundamental to the operation of the universe that it prompted this quote from a distinguished scientist:

“The law that entropy always increases, holds, I think, the supreme position among the laws of Nature. If someone points out to you that your pet theory of the universe is in disagreement with Maxwell’s equations — then so much the worse for Maxwell’s equations. If it is found to be contradicted by observation — well, these experimentalists do bungle things sometimes. But if your theory is found to be against the second law of thermodynamics I can give you no hope; there is nothing for it but to collapse in deepest humiliation. ”

–Sir Arthur Stanley Eddington, The Nature of the Physical World (1927)

But this is not the end of the story. For while the “inventor” and his supporters use the word “fuel” to refer to the water, it is a misnomer as we normally understand the word. A fuel is something that supplies energy, it stores energy that is created by one of any number of processes and enables it to be used to do work seconds, hours or millennia after the energy was first produced.

This is what fossil fuels are – the condensed energy of biological processes that occurred millions of years ago. We tap this energy and use it to run our cars, and depending on where you live, the entire rest of our lives.

So what’s this to do with water?

Well, simply put water is the end product of energy use. It is not a storage medium it is a waste product. It would be like saying you’ll run your furnace on ash. You would be laughed out of the human race. But say you’ll use the magical liquid of life – water – and for some reason people think there’s something to this idea.

Now, what is the proclaimed inventor claiming? When you get right down to it he knows the water isn’t a fuel. He is in effect using the water as a convenient hydrogen source. It is the hydrogen that runs the car, and presumably the “water-kit” enables the car to process this hydrogen as it would petrol. The kit also contains an electrolysis component that splits the water into hydrogen and oxygen. I am unaware as to whether the oxygen released is retained to react with the hydrogen or whether atmospheric oxygen is used for this.

In any case the energy for running the car comes not from the water, but the batteries used to extract the hydrogen. The hydrogen then becomes the interim energy storage medium and the “fuel” for the car.

What we have then is the energy generation being pushed back a step, instead of being done at the car via petrol, it will be handled by the country’s power plants.

I can well imagine that there are benefits to converting cars to this set-up. It effectively turns your automobile into one of this new fangled electric cars without the downside of looking like a self-righteous dick*. There are benefits to using electric cars even if the ultimate power generation comes from fossil fuel consuming power plants (which by my calculation more than half of Pakistan’s electricity comes from) such as local air quality improvements. The ability to deal with emissions at centralised locations and the possibility of sequestering that pesky CO2 at the source.

I suspect however that in the rush to embrace the technology at issue here these peripheral concerns are not really being considered. And for a country that already has too little electricity for the population it has (40% of the country has no access to electricity, and demand is ever increasing for those that do) this does not sound like such a great idea and won’t result in everyone having unlimited fuel for their cars. It can only add to the pressure on the already over-taxed electrical grid.

In addition it is being implied (if not outright stated) that water could be used to run generators. This is where you could justifiably call fraud. While there are conceivable reasons why you might convert a car to “run” on water those reason evaporate when you try to argue that the same can be done for a generator. I’m sure you can see why. You end up just inserting an extra step in the energy generation process, well more like a loop. You have to provide energy to the water to extract the hydrogen and then burn the hydrogen back to water to get the energy. Thanks to that second law thingy you will never get more energy out of that reaction than you out in.

Not only do you insert a completely useless extra step, in doing so you guarantee that the whole process is less efficient. You literally get less combustion for your buck.

I hope that no government official is seriously considering funding a project to replace generators with water powered devices, though I gather millions may be spent investigating the possibility of employing this technology in Pakistan. I don’t know where that money (assuming people don’t wake up by then) is intended to go.

This is the concern whenever fringe theories and technologies are held up as the solution to our problems, that money will be wasted on these rather than put toward more worthy projects.

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* A more thorough treatment is here, by former chairman of the Pakistani – Higher Education Commission  Dr Attaur Rehman.

** Just kidding. For what it’s worth I think electric cars are really cool and if I could spare the dosh would love to have one. But I gather there is something of a stigma and well it’s a joke – lets not analyse it too much eh?

Related articles

• Pakistan water-fulled car claims spark joy, worry

One in seven.

Think about that for a second.

One seventh of the world thinks they will see the end of civilisation as we know it.

One prediction has only a few weeks to go before hitting the cold light of reality, it won’t be the last. Why? I don’t know – You tell me.

I’ve given up, people are crazy.

As with many modalities in TCM Cupping appears to be based on pre-scientific notions of blood stagnation and energy blockages³. Applying cups with a slight vacuum to the skin is meant to draw out the “toxins” which then results in improved health, somehow.

The active part of cupping essentially boils down to a pressure difference. The pressure is lower on the inside of the cup and greater on the outside, this difference causes the skin to be forced up into the cup⁴. This process in turn causes blood to gather in the region and may cause minor damage to the area resulting in bruising.

Presumably the fact that the skin appears to be drawn up into the cup gives the impression that there is a general pulling action at work here and that toxins and other “bad stuff” are pulled out of the body in this fashion.

The trouble with this is that pressure difference is a fairly crude physical process and with regard to this biological system lacks what we in the science biz call “Specificity”⁵. What this means is that there is no way for the cup to restrict the “pulling action” to only harmful chemicals (the “toxins”, say) and allow everything else to be unaffected, i.e. it is not “specific” to toxins. Everything will be drawn up in the same way.

In which case you get a lovely bruise and feel like you’ve done something but that’s about it.

Ok, that’s fine for just thinking about it. What about evidence, we’re always going on about evidence here.

I attempted to find a Cochrane review on cupping but while one was listed for pain relief there did not seem to be a completed review for perusal. I did come across this review that found equivocal results for the effectiveness of cupping for pain.

The review comments on the putative mechanism of cupping:

“Assuming that cupping was beneficial for the management of pain conditions, its mechanisms of action may be of interest. The postulated modes of actions include the interruption of blood circulation and congestion as well as stopping the inflammatory extravasations (escaping of bodily fluids such as blood) from the tissues. Others have postulated that cupping could affect the autonomic nervous system and help to reduce pain . None of these theories are, however, currently established in a scientific sense.” [Emphasis added, citations removed]

The discussion of the reviews limitations is especially worth noting:

“Our review has a number of important limitations. Although strong efforts were made to retrieve all RCTs on the subject, we cannot be absolutely certain that we succeeded. Moreover, selective publishing and reporting are other major causes for bias, which have to be considered. It is conceivable that several negative RCTs remained unpublished and thus distorted the overall picture. Most of the included RCTs that reported positive results come from China, a country which has been shown to produce no negative results. Further limitations include the paucity and the often suboptimal methodological quality of the primary data. One should note, however, that design features such as placebo or blinding are difficult to incorporate in studies of cupping and that research funds are scarce. These are factors that influence both the quality and the quantity of research. In total, these factors limit the conclusiveness of this systematic review.

In conclusion, the results of our systematic review provide some suggestive evidence for the effectiveness of cupping in the management of pain conditions. However, the total number of RCTs included in the analysis and the methodological quality were too low to draw firm conclusions. Future RCTs seem warranted but must overcome the methodological shortcomings of the existing evidence.”

In conclusion then, you may see a placebo effect from this treatment – though I suspect this is over rated as a therapeutic outcome⁶. You may also find yourself covered in bruises (though I hear they are painless – think of them as CAM hickies). So… Dubious premise with dubious benefit, same thing – different day.

Here are a couple of images for you to keep in mind…

Mmmmm, cupping goodness.

[UPDATE 30/5/12: Islam appears to support cupping, check out this completely unbiased arabic wikipedia article]

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Footnotes:

1. Can’t get away from TLAs

2. So many jokes spring to mind, I mean come on – “cupping”?

3. See this link for some scary science illiteracy around cupping. And here’s good old Wikipedia. And “blood stagnation” really? isn’t that gangrene or septicaemia or something?

4. Keeping in mind that a vacuum does not suck, high pressure pushes.  If I may geek out a bit here; hence one of my favourite exchanges from ST:TNG:

“You were right. Somebody blew out the hatch. They were all sucked out into space.“
“Correction, sir, that’s blown out.“
“Thank you, Data.“
“A common mistake, sir.“

- Riker and Data get precise about the physics of rapid decompression into the vacuum of space

5. Yeah, I know, it sounds made up.

6. See here, here and here.

Related articles

• Vaccines and Autism – Media Report Card (sciblogs.co.nz)
• What’s The Harm of Alternative Medicine? (scepticon.wordpress.com)
• Yoga Thai Massage: Herald, Wherefore Art Thou Sense? (scepticon.wordpress.com)
• Why Do People Use Alternative Medicine? (scepticon.wordpress.com)
• The Freedom of Ignorance: Health Freedom, What is it and Do We Want it? (scepticon.wordpress.com)

Enjoy.

The Great and Powerful Tyson…

Dan Dennett on “Deepities”…

“Vectron” from the amazingly funny Mitchell and Webb….

Levitation, I have to admit while watching this I was grinning like and idiot..it’s awesome….

Richard Wiseman amazes and astounds….

Daleks: Hitchhiker’s Guide style…

Many of the comments are along the lines of “It worked for me” and “Try it yourself”.

To the first, I don’t really have much to say. I can’t peer inside the inner workings of your child and determine what is going on. But at the same time a bunch of individuals making claims of efficacy without adequate control for bias, natural history and various other contingencies is not a compelling argument to me. Plenty of others swear by practices that have no hope of working*, why should this one get more credibility based on personal experience?

As to the second, three words for you: Anecdote and Confirmation bias. I know enough to realise that I am not immune to the wiles of confirmation bias, which would make my trial just another anecdote – something I don’t accept from others so what would make my own experience any more valid? I also realise that for most people this sort of reasoning is at best foreign and at worst incomprehensible. The general thinking appears to go something like “If I try something and it seems to work, then it works – QED”.

No.

Related to this point are appeals to the “Placebo Effect”, the idea being that simply trying something helps, somehow. This may be true. But I’ll expand on the faulty reasoning behind this assertion.

The placebo effect as this seems now to be the “go-to” explanation for all things unexplained so it might be a good idea to dwell on this concept on it’s own for a bit. First off with regard to talking about the placebo effect, it depends on what you mean. The placebo effect started off being simply the improvement seen in the control group for clinical studies. It was the group that was given everything except the active treatment. Therefore by definition the placebo response is what happens when people aren’t treated. It was the catch all for everything that could affect the outcome that wasn’t due to the treatment itself: poor method design, confirmation bias, reporting bias, observer effect on the patients, regression to the mean, natural history of the disease, etc, etc.

Recently there has been some work done to see if there is a real change in people that is due to thinking they are getting an active treatment, the so called “Placebo response/effect”, this has been mixed. It is true that people will report less pain and their brain will show less activation in pain related areas. But people are susceptible to what they are told, it turns out if you tell people a cheap wine is expensive they will enjoy it more. Is there a placebo wine effect? possibly, but the wine didn’t change and neither did any underlying physiology in relation to placebo medical treatments.

In fact recent studies in asthma showed that while people reported feeling better while taking placebo their ability to perform on objective measures remained the same, while those on active medications improved. If you feel better while still having a life threatening condition are you better? I don’t think so.

So in appealing to the placebo effect you have to concede that 1. the beads don’t have any active ingredient, and 2. don’t make any difference to the underlying condition.
i.e. They do nothing.
Now notice in my original piece this is not what I say, I merely point out there is no good reason to think they are doing anything, not that they definitely aren’t. A subtle distinction I admit.

In essence the argument becomes: “If you think it works then it does”, well I would counter with why don’t you use something that we know does work and then you can capitalise on both effects: You will think it works and it will actually work too. Double goodness.

One poster asserted that amber necklaces were registered with the Therapeutic Goods Administration in Australia as a Medical Device. Arguing that this must mean they have therapeutic properties.

This one was my favourite as it was almost laughably easy to dismantle. After only a few minutes I found that this was completely untrue (you can search the TGA resister here). Not only that but there were suppliers admitting** that they couldn’t claim therapeutic benefits because they were not on the register:

“Amber Teething Necklace Information – TGA Australia

Due to regulations of the Therapeutic Goods ACT, policed by the Therapeutic Goods Administration (TGA), whose register does not recognise the claimed healing and theraputic[sic] properties of Amber we are unable to offer any detailed information on Amber Teething necklaces or Amber in general in a theraputic[sic] advisory capacity.

Therapeutic goods are defined in the Act to include goods that are represented in any way to be for therapeutic use. Therapeutic use is defined to include use in or in connection with influencing, inhibiting, or modifying a physiological process in persons.

In all amber related cases that we have seen, the TGA Panel note “that the advertisement appeared likely to breach section 42DL(1)(g) of the Act, which prohibits the publication of advertisements for therapeutic goods that are not included in the Register“” [Emphasis added]

A complaint was made against a supplier for making claims for the product and this was upheld in part because the necklaces are not on the register.

“The Panel noted, without making any formal finding, that the advertisement appeared likely to breach section 42DL(1)(g) of the Act, which  prohibits the publication of advertisements for therapeutic goods that are not included in the Register.“

The website involved changed their wording to get around the regulations, spot the difference:

OLD: “natural pain relief provided by Amber works by placing the necklace on your body, this allows your skin to warm the amber beads, releasing healing oils which are then absorbed into the blood stream.“

NEW: “Amber is believed to soothe naturally, when Amber is worn next to the skin it is warm and it is reputed to release natural oils that can care for the skin.”

What a difference a few words make.

At the time the comment was made alleging the necklaces were on the register I suspected that intended therapeutic benefits would be enough to fulfil the therapeutic benefits category.

This is supported both in the declaration of the supplier above and from the wording from the complaint, just prior to the excerpt above it states:

“Therapeutic goods are defined in the Act to include goods that are represented in any way to be for therapeutic use. Therapeutic use is defined to include use in or in connection with influencing, inhibiting, or modifying a physiological process in persons.

In representing the advertised products to have an “active ingredient”, to release “healing oils which are then absorbed into the blood stream”, and to relieve teething in infants, the advertisement clearly constituted an advertisement for therapeutic goods.” [Emphasis added]

Lets say though that the product had been registered with the TGA or will sometime in the near future, I would note that unless the administration was in possession of studies that are not published elsewhere there is no way that they could be sure that an actual benefit is occurring. Bringing us right back where we are now.

As an extra note on the activities of the Australian government on this topic I found it amusing to see that the Australian Competition and Consumer Commission issued a safety warning about Amber teething beads end of September last year (see here and here and here).

I say amusing because, while it’s not impossible, I do find it unlikely that one branch of the government is condoning their use while another warns against them. Luckily this is not actually the case.

Finally, this post is not intended to address every conceivable objection to my arguments, merely a survey of what has been proffered so far. I am not really convinced by anything I have yet seen but I remain open to changing my mind so long as the evidence is of good quality. It doesn’t have to be much, a good start would be something that suggests succinic acid has the analgesic properties attributed to it. Then we could address whether succinic acid is released from the beads at ambient/skin temperature. Finally we would need to tackle whether the succinic acid is absorbed topically in any significant dose (decent dose response curves could be obtained at stage one of this theoretical research programme).

All three of these items would need to be looked at in order to state that amber beads have good plausibility for what they are marketed for.

[Update 29/4/13: Apparently there is a chain email circulating blaming amber beads for a case of SIDS. This seemed implausible to me and a very brief check seems to back up my gut feeling. There is no reason to think that amber beads contribute to SIDS at all. For a more thorough break-down go here: http://www.hoax-slayer.com/amber-teething-necklace-sids.shtml . I am not one who feels we need to latch onto any reason to vilify our intellectual opponents and spreading misinformation (especially easily debunked misinformation) is a big no-no in my book.]

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*Not that I think this product has “no hope” of working, it could as far as I know. We just can’t make that determination on the basis of anecdote and there are no trials that I’m aware of.

** Argh, this site seems to have removed any trace of of this page. Should have archived it. It has essentially been replaced with this (archive):

In keeping with Australian Fair Trading guidelines no therapeutic claims are made and no medical advice is offered. The material provided on allaboutamber.com.au is for information and educational purposes only and is not a substitute for medical treatment or diagnosis. We assume no responsibility for treatment or cure of any illness or disease. If you have a health problem we recommend seeking medical advice from your qualified natural/health professional. This information is strictly a source of general information and is not intended for use as a tool for self-diagnosis. All About Amber provides this information for you to make your own decisions, if you want to use them on your own family, we believe they work for us and please read the reviews to gather many other peoples opinions.

Which seems to me to be saying “We can’t claim the beads have any healing powers directly, but they really do.”

They haven’t yet learned this lesson for Hazelwood jewellery (archive)though:

How does hazelwood jewellery work?

Hazelwood products are believed to help to create an alkaline environment in your body, which may help, precent[sic] and appease many of the symptoms caused by being to acidic. Hazelwood, being an alkaline wood, has the natural property of absorbing and neutralizing the body’s acidity through contact with the skin. By doing so, the necklaces can also help with digestion, constipation, eczema, migraines, acid reflux, heart burn, nausea, arthritis, skin problems, etc. If you suffer from one of these issues, it is highly probable that you are suffering from an acidity imbalance, and hazelwood may be able to help you alleviate these symptoms in a natural way.  Most people who suffer from an unbalanced pH are unbalanced towards the acidic. This condition forces the body to borrow minerals—including calcium, sodium, potassium and magnesium—from vital organs and bones to buffer (neutralize) the acid and safely remove it from the body.

Hhhhm, perhaps another post is in order. And a complaint.

As a brief aside, as it seems there are quite a few parents out there hungry for this information if you know of a good parenting or early childhood publication that would be willing to print the original article (probably in an altered form) then let me know.

And I’ll stop there before the footnotes become longer than the post.

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This year we have the Mayans to blame and it’s rather more wide spread than a few eccentric Camping followers. In my previous post I essentially put together and End of the World retrospective, surveying a small number of past predictions that failed. This time showcase the many predictions that still lie in our future.

Behold the Future History of the Apocalypse!

[Edit] I tested the Vodpod code on the Sciblogs platform and it didn’t work but the syndicated version does. If you still have trouble viewing then go Here  or Here to see the timeline.

NB. Where I couldn’t find or couldn’t be bothered looking for exact dates 1-January was substituted. Click the individual events to find the person who predicted it, move the sliders at the bottom to zoom in and out of timeframes.

Timeline Key:

Sources are given by letters, links below or can be copied from the timeline with a right click.

ABHOTA , AV  , MB , CoB , RT , L , WZ

Sources are of varying veracity and humour.

What I found interesting was the fact that the dates are mostly clustered in the period covering the next 40 years or so. Further, about 40% (9 events) occur within the next 10 years. This matches with data showing that a significant number of Christians (in America at least) believe that the second coming will occur in their own lifetime.

It’s a point I made in the previous post, but it is not a little disturbing that many people who ridicule putting a date on the “End Times” don’t do so because they think it’s not going to happen but because they think it’s a “mystery”. An interesting research project might be whether this propensity to feel the end of the world is nigh is a general human condition or a feature of religious individuals in particular. Presumably there is some innate propensity there that religious traditions use.

Anyway, plenty of opportunities for End of the World parties ahead! YAY!

[EDIT 3/05/12: I have just learned of another End of the World Event (a EWE if you will), this will be a combo of nuclear war and second coming of Jesus. Quite economical really. If I may indulge myself, a quote from the page:

"When I began writing posts for this site, I initially envisioned the possible need of writing more often, primarily due to our preparing for the possibility of “great tribulation” beginning at the very start of this final three and one-half year period. However, great physical tribulation did not begin at that time, and it thankfully has not yet begun. So the need to write more often in order to help people deal with tribulation that could have begun early on has not been needed. But rather, in the midst of horrifying prophecies for this end-time, God has revealed in a most powerful manner one of His greatest attributes toward His creation—toward mankind. It is the awesome quality of “mercy”!"

I'm not sure why this guy has put mercy in scare quotes but it is coincidental that God's "mercy" looks exactly like nothing happening at all. Looks to me like a built in excuse when the end of the world fizzles. More economy, handy that. Via UnreasonableFaith]

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I don’t think it’s quite as simple as that. A study “Why Patients Use Alternative Medicine” published in 1998 in the JAMA looked at this question using a survey sent to randomly selected participants. 1500 participants were sent the survey and 1035 completed it. Not too bad for a survey response rate.

The survey was geared to look at the use of altmed based on three paradigms:

“1. Dissatisfaction: Patients are dissatisfied with conventional treatment because it has been ineffective,5-6 has produced adverse effects, or is seen as impersonal, too technologically oriented, and/or too costly.

2. Need for personal control: Patients seek alternative therapies because they see them as less authoritarian16 and more empowering and as offering them more personal autonomy and control over their health care decisions.

3. Philosophical congruence: Alternative therapies are attractive because they are seen as more compatible with patients’ values, worldview, spiritual/religious philosophy, or beliefs regarding the nature and meaning of health and illness.”

According to the survey results satisfaction, or lack thereof,  with conventional medicine did not correlate well with altmed use. 54% of respondents reported being “highly satisfied” with conventional medicine providers, of these 39% use alternative therapies. Of those who were highly dissatisfied (40%) only 9% were users of altmed.

It seemed as if those who were fans of medicine overall were more likely to participate in both camps. A sort of “the more the merrier” approach to health care.

What was predictive of alternative medicine use was personal philosophy. Those who considered there to be a strong mind/body/spirit connection as well as those who had had a “transformational experience” were more likely to use alt med than those who did not.

Education and health status also correlated with altmed use. Those with higher educations were more likely to use it, as were those who described themselves as having a lower health status.

The situation was slightly different for those who shunned conventional medicine altogether in order to embrace altmed. These folks tended to be distrustful of and dissatisfied with conventional practitioners, as well they desired a high degree of control over their health and believed in the importance and value of “inner experiences”.

This proportion of the population was quite small however – only 4.4% of the survey respondents fell into this group. Even so somehow the reasons for this group’s embrace of altmed has been generalised to the wider population.

The observation that users of altmed tend to be greater consumers of health services overall is also supported by the paper “Association Between Use of Unconventional Therapies and Conventional Medical Services“. This survey had a base of 16,068 individuals from which to pull data representing a 77% response rate from the 24,676 pool that was originally sampled.

According to this survey only 6.5% of the population use both altmed and conventional medicine** (and 1.8% using only altmed), with this group making more visits to their physician than those who used conventional medicine only. One possible reason for this is the so-called “worried well”, a portion of the population that focuses on their health to a degree higher than would be expected given their health status. Support for this is given within the paper:

“Compared with those with only conventional visits, those who used both types of care had significantly more outpatient physician visits (7.9 vs 5.4; P<.001), and used more of all types of preventive services except mammography. These groups did not differ significantly in inpatient care, prescription drug use, or number of emergency department visits.”

This on it’s own does not show a “worried well” connection but in the comments section of the paper it was noted:

“…there was no difference in any of the 4 self-reported health measures between respondents who had physician visits only, and those who had those visits in conjunction with unconventional therapy. Poor health status appeared to drive use of health services in general, that is, those using no services reported better health than those using either conventional medical services or unconventional therapies. However, poor health was not associated with increased use of unconventional therapies over and above conventional medical care.” [emphasis added]

So it would seem, at least in this sample, that dissatisfaction with conventional care cannot be the driving force for the majority of altmed users. More plausible is that altmed users seek to make the most of every perceived avenue for health.

Another survey published in 2001 also supported the general conclusion that dissatisfaction with conventional medicine does not lead to altmed use for most consumers. “Perceptions about Complementary Therapies Relative to Conventional Therapies among Adults Who Use Both: Results from a National Survey” surveyed 831 respondents who used both regular and alternative medicine.

Of these 70% would visit a conventional medicine practitioner as their first port of call. Only 15% went to a altmed provider first. There was also no significant difference in the level of confidence in altmed providers and regular medical professionals.

To quote the conclusion:

“National survey data do not support the view that use of CAM therapy in the United States primarily reflects dissatisfaction with conventional care.”

From a paper presented at the Proceedings of the 1997 Conference of
the Australian Association for Social Research and published in the Journal of Sociology; “Postmodern values, dissatisfaction with conventional medicine and popularity of alternative therapies“[PDF File download]:

“Those individuals who value natural remedies, are against chemical drugs, do not favour technological progress, and welcome variety in choice of therapy are more likely to have a positive attitude towards alternative medicine.”

These attitudes were enveloped under the “postmodern” rubric and were found to be a better predictor of altmed use than satisfaction levels with regard the conventional medicine.

To elaborate on that point, a further finding was that dissatisfaction with interactions with physicians rather than health outcomes was associated altmed use. This is a subtle point and worth dwelling on as it seems to be a valid criticism of the way in which conventional medicine is practised. It was not that altmed users were unhappy with the actual results of the care received via conventional medicines but the way in which they feel they are treated by doctors.

It seems that those turning to altmed may feel that conventional doctors do not give enough respect, time, don’t listen and are too authoritative. I don’t want to put too much emphasis on this perspective as it isn’t entirely consistent with the picture built up so far and the sample size of this survey was relatively small compared with the ones above (only 209 respondents), but it is worth considering.

In conclusion, while it might be true that some dissatisfaction does lead to an increase in the use of alternative medicine it seems unlikely to me that this is the main reason. I’m not sure why it has become the go-to reason trotted out by participants on both sides of the debate, ease I suppose. I could of course be wrong, perhaps there is a mountain of research out there that I’ve missed pointing in the complete opposite direction. I’m willing to grant that possibility, in the absence of such though I’ll have to go with personal philosophy being the largest contributing reason people use altmed.

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*I hate with a passion the label “Western Medicine”, what? – people from other cultures can’t use science? Nonsense.

** I suspect that the wildly differing definitions of what constitutes “Alternative” medicine are to be blamed for the fluctuating figures around the proportion of users.
————————————————————————-

Astin, J. (1998). Why Patients Use Alternative Medicine: Results of a National Study JAMA: The Journal of the American Medical Association, 279 (19), 1548-1553 DOI: 10.1001/jama.279.19.1548

Eisenberg DM, Kessler RC, Van Rompay MI, Kaptchuk TJ, Wilkey SA, Appel S, & Davis RB (2001). Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Annals of internal medicine, 135 (5), 344-51 PMID: 11529698

Druss, B. (1999). Association Between Use of Unconventional Therapies and Conventional Medical Services JAMA: The Journal of the American Medical Association, 282 (7), 651-656 DOI: 10.1001/jama.282.7.651

Siahpush, M. (1998). Postmodern values, dissatisfaction with conventional medicine and popularity of alternative therapies Journal of Sociology, 34 (1), 58-70 DOI: 10.1177/144078339803400106

Aditional reading:

Joy, J.M. (2004). Complementary and Alternative Medicine (CAM): Do Barriers to and Dissatisfaction with Traditional Care Affect CAM Utilization Patterns, Masters Thesis, Texas Tech University Health Sciences Center

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A while ago I was accused of advocating that doctors should break the Hippocratic oath. That the cardinal rule of “First, do no harm” should be ignored. Setting aside that this phrase does not appear in the Hippocratic oath, what do we mean by harm in the context of medicine?

I was reminded of this by a post on Science Based Medicine by David Gorski in which he muses over the measure of patient satisfaction as a proxy for how well hospitals meet their obligations with regard to patient care. To kick it off the good doctor notes that many interventions used by modern medicine cause harm, often direct harm.

Does this mean that doctors are throwing out their obligation not to harm patients? No, because we recognise that the concept of harm in this case includes those harms that would occur were we to withhold treatment as well as recognising that the total harm is reliant on the amount of benefit obtained by the patient.

The accusation against me was in the context of my arguing against the claims of anti-vaccinationists that vaccines do more harm than good. I don’t want to rehash that argument here but I do want to dwell a bit on our concept of harm and how it applies in the medical arena.

One of the themes that return to over and over again on this blog is that of risk vs benefit. The amount of harm or risk can only be appropriately assessed in light of the benefit accrued. As pointed out by doctor Gorski there are many procedures that hurt, they hurt a lot. Should a doctor refuse to perform them then? Even if they could save a patient’s life?

Of course not.

It is plainly ridiculous to assert that short term harm out weighs long term benefit, it might but that calculation has to be made in each case. In many cases the benefit will be clear, in others less so. If a patient undergoes a painful procedure that is relatively short lived and then makes a full recovery then the choice is fairly simple. If the recovery is likely to be only partial and the patient’s quality of life is ever after severely reduced then we may weigh up the benefits of that treatment differently.

What then of treatments that are good for most but may harm a few? These are the tricky cases and it depends on a few variables. One is can we identify the persons that will be harmed,  second, how much harm are they likely to suffer and what percentage of the treatment population do they make up? Finally what total benefit will accrue to the population if treatment is green lit?

I listed these variables in the order of importance I estimate they have. If we can identify prospectively harmed persons then they may be removed from the treatment group, harm avoided. If this information is unavailable then we may move to the next criterion: how much harm will they suffer? If this is likely to be relatively mild then all to the good. If the harm is considerably more serious then we may stop the treatment altogether in order to avoid these instances. The last two variables may switch in order depending on the situation or individual values.

Should a vital treatment be withheld from the general population if a very small percentage with be greatly harmed by it? Frankly I don’t know. Help – is there a Medical Ethicist in the house?

Often I’ll find that the people who oppose modern medicine will emphasise the risks of medicine while over-hyping the benefits of alternative medicine. The claims that iatrogenic (caused by medical treatment) harms are enormous abound. This point of view seems completely ignore the benefits received by individuals and society by medicine in it’s current form*.

This seems perverse to me, the idea appears to be that any risk is unacceptable – a completely untenable position to my mind – every action carries risk. I take my life in my hands every time I drive to work, but the risks a relatively low and the benefits are more important to me – and the majority of other drivers I suspect. To argue that we should abstain from automotive transport until it is completely safe misses the point entirely. As does decrying the risks of the majority of medical science in the face of the undoubted benefit received.

To conclude this ramble, harm or risk is part of the human condition. Arguably the complete removal of risk is not only impossible but not even desirable**. We have to live with risk and harm, the key is to ensure we balance these against the good that comes from acting in the world to oppose even greater harms.

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*This is quite an extreme view and I would hasten to add that I don’t think the majority of alternative medicine users (however you may break that group down) would subscribe to it, but it exists.

** Depending on how this might be achieved. Possibly we could make ourselves impervious to harm rather than removing everything that might harm us.

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