Saturday 15 August 2009

Adventures in Nonsense, Correlation, and Pity

I am having great fun reading the excellent blog "Adventures in Nonsense" by Simon Perry, he who, unknowingly along with Zeno, sent the 500 individual complaints about incorrect claims made by chiropracters. I was very interested to read a reply he received from a "Dr" Paul Homoky in response to a request for this evidence chiropractic claims to have that it treats colic.

Read the post and particularly the letter here.

In the comments especially, the question is emphasised: Are they claiming to treat colic or not? The chiropractors say no, we're not. But it seems that there is a claim on their website that colic may improve after treatment.

First of all, colic probably improves after treatment because colic goes away on its own anyway. A blind trial would demonstrate whether it goes away faster or more commonly (or what have you) following chiropractic than following no treatment, or some other treatment. I am sure such a trial would have been unearthed by now if there were such results?

But there is an interesting point raised here. Scientifically, a lot of things can happen in conjunction. Place a beaker of cold water over a Bunsen burner flame, and you'll find after a while that there's a lot of steam in the air. Therefore, the Bunsen burner flame gives off steam? No, of course not, the water does. The two do happen in conjunction, though.

Or take the case of a patient with anxiety and irritable bowel syndrome and a general feeling of ill health. The doctor prescribes an antidepressant for the anxiety. The anxiety diminishes - and the irritable bowel syndrome and general health also improve. The antidepressant was not prescribed for the physical symptoms, but it did end up affecting them. Improvement in one thing may lead to an improvement in others. The mind and the body work very much together: it is all too well known in the teaching profession that teachers suffer from illness in the holidays because their bodies hold it off until they have time to be ill. (Or, if the stress overcomes them, they get ill a lot during term time.)

It's all a bit like this great XKCD comic, Correlation:

I have the feeling that if we had a well-educated, scientifically aware and confident public, there actually wouldn't be a problem with presenting the case scientifically. Get some treatment, and your general health is likely to improve. As things are, there are just too many problems associated with that.

For one thing, chiropractic is not as risk-free as claimed. For another, it's operating as a business, and therefore it should be subject to the same standards as other businesses. I remember an incident when I was very little: I noticed an advertisement on a shop sign saying "A Mars a day helps you work, rest and play". I remarked to my mother that surely that wasn't true. She said indeed not, and they had in fact been prosecuted for saying it.

"Dr" Homoky challenges Simon Perry with the statement: "I wonder if you have applied the same rigorous analysis to a wide range of medical treatments which are provided by medical doctors on a daily basis—many of which are proven to be ineffective, unnecessary and/or carry a high risk of negative outcome." The difference is that this is well known and acknowledged. If I go to the doctor and am prescribed a medicine, they say, "Make an appointment for a week's time, and tell me how you're getting on with it. It's different for everyone. If it doesn't work for you, we'll try something else." A good doctor will discuss an operation with a patient and their family before they go ahead with it, so that they know the outcome may not be what they want. Traditional medicine does not claim to provide miracles.

A patient is a vulnerable person. They're often tired, their minds are seldom at their best, and they may be lonely and very stressed and unhappy. That, I believe, is at the heart of what's wrong with the government's great idea of providing "choice for patients". I know what it's like to be severely ill, and the last thing you want then is to have to make choices. If the patient chooses, they're still responsible and in charge just when they need a break. It also means that if they make the wrong choice, the outcome is their fault - I can't think of anything that would make one more bitter about lasting ill health. If you really are ill, you need someone knowledgeable to take over. I don't make these statements lightly; not only have I experienced serious illness but come from a medical family.

Chiropracters are posing as these knowledgeable people. A suggestion that they will help your screaming baby's colic sounds like a godsend. And that's why more care is required: they're not addressing a scientific journal, but often very tired people who want quick remedies and often lack knowledge. Ah - how very convenient.

According to the e-mail Simon Perry received, knowledge is none of the public's business. "I’m afraid I won’t be sending you any information . . . I was happy to provide details to the Edinburgh Council as they requested, but this is, quite frankly, our business and not yours." Not to mention criticising Simon Perry's not talking to him whilst making it clear that he's far too busy to talk!

I also couldn't help noticing that behind the very friendly, polite tone of "Dr" Homoky's letter was the tactic of guilt trips. "My new wife and I have had our first baby, and we would like to enjoy his beautiful entry into the world. Please do not send any further emails to me." He's made it clear he's not on leave, he has the time to be practicing, so the implication is that Simon Perry is preventing him from enjoying his baby by e-mailing. This "poor little me, my feelings are so hurt" attitude seems to be the reasoning behind which the BCA sued Simon Singh, too. Diana Wynne Jones has written a wonderful book "Black Maria" about how people use guilt to control others!

In effect, it's using weakness as a weapon: not countering an argument, but "You wouldn't stoop to hurt me, would you?" Now I'm being very naughty to go down this route, but I suspect clashes between this approach, and the more straightforward battling one, is one symptom of cultural clashes. When I was 21 I lived in southern Spain, and it was well known that the Spanish and the Moroccans didn't always get on. I hadn't been there long when I noticed that, while the Spanish often enjoy a shouting match, the Moroccans tended (no, I am not saying "exclusively Moroccans" or "they always did this" - I don't want to judge or generalise, merely to report something I spotted over 10 months) to use the weakness approach, particularly in facial expression. It was only days before I found that the less help I asked for, the more determined I was to settle my own problems out there, the more the Spanish bent over backwards to help me. They admired independence. This snippet has no relevance to the BCA or the e-mail other than entertainment, and the tentative suggestion that it's a cultural difference. Science enters straightforward battles. Chiropractic says "Poor little me". What do you think?

All in all, I can't resist quoting just once more from Ben Goldacre's wonderful article that led to my previous post: "You may view this as bullying individuals, and initially I had some sympathies. But my heart was hardened." Poor Little Me is not a statement of competence or truthfulness. Would you put your health in the hands of a doctor who refused to give you information but only asked you to protect him? I don't think so.


Simon said...

Something that I didn't mention on the email, to add to the sympathy he attached a photo of him with his child to the email. Nice post Alice, thanks.

Anonymous said...

I am going to be awkward... A Bunsen burner burning gives of CO2 and H2O (as steam) - Sorry

Alice said...

I will go and hang my head in shame - that is, once I've finished beating it against a brick wall (because last time I said that my own comment went down a black hole!).