Dr David Grimes: challenge claims and stand up for science

You raise a good point there – individually, it is very difficult to ascertain whether a claim is honest or not. Collectively, however, this becomes exponentially easier. One of the reasons I have so much time for Sense About Science is that they essentially serve as a central hub for this very purpose, and one that will improve as more people contribute to it. I’d love to see the system you mention implemented, but as you correctly point out it will certainly not happen overnight!

As in other “policing” areas this is a question of scale – imagine the number of adverts and then the number of experts, bodies and beaurocracy needed to adjudicate. I do not think it feasible.

I would rely on people in general and expert organisations reporting blatant advertising misrepresentation and requiring supporting evidence form the advertiser to support their claim. The cost of investigation should be paid by the advertiser, refunded only if the claims were true. If untrue, the company should be fined and, if fraudulent, criminal proceedings take. Is Trading Standards the starting point – if only we had a well-funded national organisation.

We do have to learn how to deal with persuasive adverts that are not untrue but appeal to our emotions. Every organisation that sells products or services wants to persuade you to buy, so will miss out the negatives. Is that misrepresentation?

How would MPs survive in this scenario?

Ask for the Evidence I am proud to say I used a few days ago querying the lifetime use claims on electrical drills.

However the problem remains that unless there are penalties for making unverified or unverifiable claims we are not much further forward in preventing them. The interesting case of Cokes Vitaminwater where its US counsel argued that a normal person would not believe that it contained vitamins is on record and googleable.

http://www.theguardian.com/society/2014/feb/03/worldwide-cancer-cases-soar-next-20-years

What’s the relevance of that piece? Cancer diagnosis has been rising for decades and will continue to rise as the population ages. You have to die of something, and the more you don’t die of injury, infection or heart disease, the more you’re likely to die of cancer.

Homeopathy has no supporting evidence so, on this basis, should be banned. However the NHS has some Homeopathic hospitals and some GPs practise it. Presumably these are scientifically-trained logical people. Just to illustrate the difficulty.

Is it just is important to disprove something as it is to prove it? On the one hand homeopathy may work, or the thought it will work might be sufficient to help some people; against that, using homeopathy instead of a mainstream treatment might be damaging or fatal.

I think Malcolm a lot more research is needed in the field of homeopathy and the placebo effect.
Each and everyone reacts differently to a variety of remedies which is evidence of our uniqueness. Tighter regulation is essential to prevent charlatans from profiteering from other people’s misery. The National Institute for Clinical Excellence (NICE) is the official governmental body appointed to approve and regulate malpractice and misrepresentation.

All the research so far has shown no demonstrable effect. So far. As you say, maybe more is needed. I think we may share a view in principle. However, my point was where do you penalise advertisers when proof for and against can be vague? And, as you say, at what point does misrepresentation become an issue? Do we all need multivitamins?

As an aside, W.R.T homeopathy, this is something I authored a few years back. TL;DR version: modern physics does not lend much support to homeopathy.

http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2012.01162.x/abstract

Beryl – I agree that more research should be done on the placebo (and nocebo) effect. But you’re giving homeopathy a level of legitimacy by comparing it with placebo. It’s a sham and I don’t want any of my taxes to go towards it.

Charles, being given a treatment you believe can help you, even if it has (to others) no proven beneficial effect, is surely good enough for it to be classed as a placebo? And if that belief works, then surely that is good? I have not a clue whether placebos can be beneficial. Do we have any research to demonstrate any effect?

I’m almost sorry I introduced homeopathy. As an engineer I do not see how it can work, and I see proponents of it but not evidence to support it. Lack of evidence is good enough for me to discount it for my own use. But – evidence is not always easy to find, even though we believe some things work. I’m sure it is a myth but I remember being told that by the laws of aerodynamics a bumble bee cannot fly, yet it does. Some believe in dark matter but, as yet, I don’t know whether we have found any, have we? Hypotheses are used to help explain situations when proof is scarce.

The key in this conversation is critical thinking – keep an open mind and look at available facts. Then make your best judgment. You might make the right choice.

Malcolm, “more research is needed” is the endless mantra of those who promote quackery. Sometimes no more research is needed.

Homeopathy is, by now, solidly shown to be worthless, but they still want “more research” because every now and then chance will throw up a positive result they can use to keep the flame alive.

It is ethically indefensible to conduct any further human studies on homeopathy until the following conditions are met:

1. Proof that like cures like as a general or useful principle. It’s based on a single speculation by Samuel Hahnemann over 200 years ago, that cinchona bark cures malaria because cinchonism is “like” malaria. Actually it cures malaria because it contains quinine which kills plasmodium falciparum, the parasite that causes malaria. There is absolutely no reason to believe homeopathy should work in the absence of a robust proof that like cures like, and that symptomatic similarity has any role in the treatment of disease.

2. Proof that dilution increases potency. Thus far not one study has decisively answered the question of how many shakes are required, how many strikes of what force, or whether the shaking and striking is even necessary, and no test, however sensitive, can tell the difference between two similarly prepared remedies at normal potency.

3. A credible – or even remotely plausible – mechanism of action. Homeopaths focus on bits of research showing apparently anomalous effects in water, but in reality even if water did have a memory and it was persistent and somehow related to the magical property involved in symptomatic similarity, the bioavailability in a remedy as normally presented would be zero. It’s very common for drugs to fail to make it to market because it’s simply not possible to deliver them to the affected organ in a meaningful dose without unacceptable side effects. The human body has a superb engine for preventing things we consume form making it into the bloodstream without being broken down into the usable parts.

Of course homeopaths will arm-wave about “energy”, but they are never able to specify what form of energy or how much. Energy is measured in Joules and is physically measurable, it’s not a synonym for magic.

Charles: Looking at it from a psychological point of view my research has come up with the best and most interesting study I think on http://www.psychologytoday…/exploringtheplaceboeffect/11nov2012. Dr Novella explains how endorphins in the brain contribute to and people with high levels of dopamine are more likely to experience placebo effects. Fascinating stuff!

And I’m not picking on you, it’s just that homeopathy is a particularly unambiguous example. Acupuncture is an interesting one – it has by now been convincingly demonstrated that it doesn’t matter where you put the needles, so meridians and qi are out (as expected, given their inconsistency across traditions and lack of empirical evidence of their existence). Recent experiments also cast serious doubt on whether it actually matters if the needles are even inserted, so it’s very likely that acupuncture is purely a theatrical placebo – a small amount of research may be justifiable, but there are risks associated with the practice so careful attention is required to the ethics of any trials.

Interestingly, the US National Center for Complementary and Alternative Medicine (NCCAM) has spent about two billion dollars on trials of various CAM practices, and failed, thus far, to validate a single one. It’s my strong belief that anything still in the “alternative” bucket is, by now, not worth looking at, and that’s doubly true for those which have become alternative only after being refuted scientifically – HCG for weight loss, chelation therapy for heart disease and autism and so on.

Minchin’s Law applies.

Guy, as I said I do not believe in the principle – so I agree with your comments. However I also believe in the freedom of people to carry out research into whatever they choose – but to present those results for peer review and not launch them on the unsuspecting as proof of their belief (or opinion). MMR vaccine acceptablilty was damaged by, I believe, lack of a proper approach, wasn’t it, and that was by supposedly reputable people. People whose views we would normally respect.

But, we make little progress if we stifle free thinking – even from cranks. Our belief and opinion might just turn out to be wrong.

Sure, people should have freedom to investigate anything, scientifically, but there are ethical considerations too. The rules for conduct of human studies are set out in the Declaration of Helskinki and they require that there should be evidence that the experimental population be likely to benefit from the outcome of the research. This is a very hard sell with homeopathy. While there’s undoubtedly a strong case to be made that there would be benefit from withdrawal of homeopathic nostrums as purported treatment and/or prevention of serious disease, there’s compelling evidence that no negative study outcome is likely to influence the practice of homeopaths. The Society of Homeopaths has publicly stated that homeopathy should not be promoted for prevention or treatment of serious disease, but in submissions to the House of Commons on antimicrobial resistance and homeopathy generally they have pretty much stated the opposite.

The problem with treatments not anchored in reality is that they have no system for self-correction. The entire purpose of medical research is precisely that: self-correction. Marshall and Warren corrected centuries of incorrect practice by demonstrating that duodenal ulcers can be caused by infection with helicobacter pylori, and that changed the standard of care very quickly. I have never seen any evidence of any alternative practitioner amending their practice in response to a study that finds any part of their beliefs to be incorrect.

I suggest we turn our attentions from homeopathy to some of the dodgy claims currently used in advertising. Any reasonable person will understand the scientific explanation why homeopathy cannot work, so that puts homeopathy in the category of belief – like religion. Both are interesting to explore but extended debate achieves little.

David’s article in Focus on Alternative and Complementary Therapies uses the solar system to help visualise the dilution involved in homeopathy. This is a useful approach for anyone who finds it difficult to comprehend very large/small numbers. I don’t believe the full text is freely available.

That is precisely the problem: As long as homeopaths can advertise even the vaguest health claim without being challenged, the controls on dodgy claims are insufficient. It is a litmus test.

I am a big fan of the ASA, and have met them in person. They are one of the few groups who will challenge dodgy health claims. MHRA have done nothing about sale of Rife machines, Trading Standards have now woken up to the Cancer Act and scored some convictions but the consumer protection from unfair trading regs are essentially unused against quacks and charlatans.

And may quacks use code in adverts anyway but make bogus claims dace to face. Some for example advertise chelation and CEASE in one place, talk vaguely about autism in another, and let the public join the dots.

As a physicist, I get a little irked when people invoke quantum entanglement as a deus ex machina; that’s not how it works. Quantum mechanics is deeply weird and wonderful, but it obeys rules and has clearly defined interactions. There is simply no evidence that homeopathy works, nor that water is somehow quantum entangled with bonds that less than a few femtoseconds…

I very much agree that we need to raise awareness of false product claims and to have suitable penalties in place, but the problem with this approach is that companies are likely to have a period in which they can profit by the sales of these products and some of the customers will be miffed when they are withdrawn. One thing we don’t want to encourage is public distrust of science.

As I suggested above, product information and advertising claims need to be scrutinised before products are put on sale, and this will have to be funded by the companies. Companies can save costs by not constantly changing their products and marketing. Since that would apply to all companies, it’s an even-handed approach.

Thanks for the reminder about the AllTrials campaign, Dieseltaylor. I signed up during an earlier Conversation.

Accounts auditing is funded by the companies – look how well that works (Tesco??). It would have to be independent and expert – where are all those resources? I’d rather see them deployed doing something more constructive. Instead, respond to significant reports of advertising malpractice with a properly funded body – Trading Standards? Ensure that adequate penalties are in place for misleading, deceptive or untrue claims to make it commercially not worthwhile; we want to prevent it, not just catch culprits.

Malcolm – I agree that claims would have to be vetted independently and experts. That would have to be funded by the companies wanting to market their products. If no claims are made then there are no claims to be tested.

Trading Standards is not coping at present and there is no indication that this will change soon. Even if more money was available, the current remit of TS is to investigate reported problems. What I am suggesting is to vet claims before products go on sale. In many cases it has been established what product claims are permissible for ingredients used in foods, so other producers of similar foodstuffs can make the same claim.

Introducing a novel claim will be what costs money, but a company should be prepared to provide good evidence to support their claim and pay for this to be independently vetted. What I am suggesting is that claims are scrutinised before the product goes on sale instead of waiting until the Advertising Standards Authority has received a bunch of complaints.

wavechange, I understand what you are proposing, but simply believe that there are too many new claims for it to be practical to vet every one – good, bad or indifferent – before they are marketed.

If there are many new claims (I was not aware of this) then all the more reason for having these vetted before products go on sale. If these claims are just new to a product but acceptable for similar products, there may be no reason for investigation or delaying the launch of a new product.

I don’t see that it is impractical to vet new claims before products go on sale.

It won’t happen because the supplement industry won’t allow it to happen. We’re not quite as bad as the US, where supplement industry stakeholders in government pushed through the DHSEA, an Act that effectively prevents the FDA from even looking at a supplement unless people are clearly being harmed by it, but we’re not far off.

It’s interesting to see the fallacies used by the supplement industry when Europe looked at restricting maximum vitamin doses on sale (i.e. pushing back against vitamin megadose quackery) – they presented this as Europe wanting to take away your vitamins. This claim was of course entirely false.

I appreciate that the supplement industry is a big problem, Guy, but that should not stop us making inroads elsewhere.

I agree, but I don’t think you’d ever be able to have a system where all marketing claims are subject to prior approval – that would be a bureaucratic nightmare. The ASA do a pretty good job, I think the only thing that needs to change is that there should be an offence of false advertising, and it should be possible for courts to issue injunctions forbidding people form repeating advertisements that have been adjudicated as false.

It’s the difference between moderation and retromoderation, in online discussion terms. Moderation is a guard, a deterrent, and means that only the most motivated even participate, whereas retromoderation is a traffic policeman, keeping people’s minds on the consequences of stepping outside the boundaries.

I agree the ASA does a job – but they are so outgunned it is unreal. We need to reset the average punter so the default setting is to be a little skeptical – question what you see/hear – or as David describes: Ask for Evidence. Great little campaign and will be interesting to see where it goes.

I totally agree. I think critical thinking should be a core curriculum subject in schools, but I suspect that no politician in the world would risk giving rise to a generation capable of analysing their claims rationally.

If (and this is obviously a massive if) politicians are using good evidence then there’s nothing to fear – I hope we see lots of people cheering when Ask for Evidence finds people/companies are using good numbers to justify statements.

I agree with you. Handwash has become a ‘lifestyle’ product promoted in fancy bottles with alluring names, pretty colours and beguiling fragrances. This is marketing, and more or less what i would expect. What annoys me is that this stuff is given added currency by the editorial content of ‘lifestyle’ magazines and other media that probably knows better but is frightened of losing valuable advertising. The hygiene-in-the-home scare has even reached the point where manufacturers have come up with battery-powered no-touch dispensers of hand cleansers. No doubt automatic sterile latex glove applicators will be next [put your hands in the pod and they come out ready-wrapped for household chores]. This is another area where sensible education would make a difference.

One of the issues I see with the widespread use of alcohol hand disinfectants is that poeple stop looking at the wider picture.
We are encourgaed or even mandated to use these when visiting hospitals, dentists, blood donor sessions , but no attempt is made to stop almost instant recontamination by everything we then touch which has not been cleaned. i.e. seats contaminated by clothes, forms or leaflets handed out.

I can see the value of alcohol-based disinfectant where there is a risk of transmission of an infection from a sick person or where someone is very ill in hospital and at risk of infection. I see no reason for using antibacterial handwash in the home, when ordinary hand washing does an adequate job.

What concerns me is that the manufacturers are implying that we need these products in the home.

Exactly. I am not aware of any credible evidence that the antibacterial products confer any benefit over good old fashioned soap, when used correctly, and I seem to remember a publication showing precisely the opposite, but I can’t find it now.

Soap, hot water, a decent nailbrush, and none of your microbeads thanks all the same.

Beryl – You have asked for the reason that homeopathy does not work. The reason is that the extent of dilution is huge and any active component will no longer be present. A disproportionate amount of time and effort has been put into investigations of homeopathy already. We need to move on, but I don’t know how that can be achieved.

wavechange, I belive that as well. However clearly some people do not – including people within the NHS. Just because we hold a particular opinion – even when quite well founded – it does not mean we should be dismissive of contrary views. If someone wants to continue investigating an apparantly dead-in-the-water topic, that is their affair – providing public money is only used for more promising projects.

What we need to do is first, educate people not to take everything at face value, second to do some basic research – internet and books – and third to use critical thinking and common sense to reach their own conclusion. May get it wrong, may get it right, but at least they have made their own judgment.

Malcolm – I’m normally very guarded but I put homeopathy firmly in the same category as perpetual motion machines. We have a well respected explanation – the placebo effect – of why homeopathy appears to work. I hope that the NHS will discontinue involvement with homeopathy but maybe not until we have a Health Secretary who does not support the approach.

Critical evaluation helps only where you have gained enough experience. It will not help if you encounter a product that claims to be beneficial to the health of your heart, for example. My advice is to be very wary about what is published on most websites.

No, the general consensus is that homeopathy is fraudulent and any claim to treat or cure any condition is without objective merit.

We already have that explanation. Naturally it’s incomplete, as most things jn medicine are. The placebo effect includes the effect of expectation, distraction, observer bias, natural course of disease, regression toward the mean, cognitive bias and so on.

People feel better because they are “doing something” so focus less on the condition, they improve because they were going to anyway, they say what they think the practitioner wants to hear, they take other treatments and so on..

Guy, I couldn’t agree more. All of which takes place in the mind or the brain whichever you feel comfortable with. One day this will all be measureable, I hope I will still be around to witness it!!!