Detoxification: free your mind of nonsense, and you’ll feel better

Here are the money quotes from today’s New York Times article on detox programs that supposedly flush toxins out of your body:

“It is the opinion of mainstream and state-of-the-art medicine and physiology that these claims are not only ludicrous but tantamount to fraud,” said Dr. Peter Pressman, an internist with the Naval Hospital in Jacksonville, Fla., and a critic of detoxification. “The contents of what ends up being consumed during a ‘detox’ are essentially stimulants, laxatives and diuretics…

“There is absolutely no scientific basis for the assertion that the regimens popularly defined as ‘detox’ will augment the body’s own capacity for identifying and eliminating your own metabolic wastes or doing the same for environmental toxins,” Dr. Pressman said. “I advise patients that these detox programs amount to a large quantity of excrement, both literally and figuratively.”

Dr. Frank Lipman, a specialist in integrative medicine in New York and the author of the book “Spent,” puts it a little more delicately: “People are selling a product. There’s a difference between selling a product and practicing good medicine.”

One of the curious rhetorical features of detox is the idea that the body is overburdened with toxins from the environment, that it’s “constipated” with chemical gunge that shouldn’t be there. And yet, the body would still be exposed to chemicals, good and bad, even if the last pollutant disappeared into a wormhole and we instantly became vegans.  In short, chemicals are chemicals, whether they come from carrots or laundry detergent and the body either does a good or bad job of metabolizing them, and the result is either that they are harmful or not. Detox simply lacks scientific credibility by making a linguistic distinction that the body, does not and cannot recognize.

And if you’re going to make yourself feel so bad in order to feel so good, there is also the possibility that you’ve just given yourself a painful and expensive placebo.

Scientists need to speak out more quickly on bad science says Financial Times

In honor of the 200-year anniversary of the birth of Charles Darwin, and the 150-year anniversary of the publication of the Origin of the Species, the Financial Times took a swipe at a) burgeoning scientific illiteracy, b) the mass media, and c) scientists.

Darwin, the paper noted, is not merely worth remembering for the sustained attack on evolution over the past decade, but as a symbol of the systematic degradation of evidence in public debate over science-based policies. This starts with general ignorance or faulty data or methods, is spread by the mass media, and is not stopped by the scientific community:

The campaign against the MMR vaccine, which has cost many lives by delaying the elimination of measles from Europe, demonstrates the harm that can come from ignoring overwhelming scientific evidence. A faulty study suggesting a possible link between MMR and autism was quickly picked up by anti-vaccine campaigners and amplified by the media. Scientists could have limited the damage with a quick response, pointing out the defects in the study and the evidence for the safety of MMR – but, as so often happens, they reacted slowly and reluctantly.

Mavericks are occasionally right: the few who warned in the 1980s that mad cow disease might affect humans come to mind. But any extraordinary claim must receive extraordinary scrutiny – and be weighed against all the evidence.

We need far more scientists than are available today to speak out quickly and firmly when reason is under attack. And in the long run we need a scientifically literate population, better educated about what constitutes valid evidence to support a particular viewpoint.”

It would surely surprise many journalists to know just how much contempt there is for the press among scientists in all fields. In one university department in a field of absolute critical value to public health, only one of the faculty will speak to the press, and then only on the condition that they can review their quotes in the final piece.  Another leading expert in a particular field said he didn’t bother to correct a New York Times reporter, even though that reporter totally misrepresented what he said, because he didn’t want to lose access. A leading cardiologist pronounced the media’s reporting of statistics in medicine “disgraceful” – these are just a handful of anecdotes STATS has heard in the past couple of years. What they all have in common is this: scientists will criticize the media for ripping their work and other people’s work out of context and to fit a narrative that simply doesn’t reflect the weight of evidence.  But instead of doing something about it, they just complain to each other.

Scientists will also call out their colleagues bad research at the drop of a hat: it’s not a surprise to find (or that difficult to find out) that some of the scientists whose names routinely appear in certain publications have little credibility with their peers; but don’t expect this criticism to ever make it on the record. Nobody wants to rock the boat or do something that could jeopardize their career.

Cardiologist Steve Nissen, who drove Congressional hearings on the safety of diabetes drug Avandia, has been torn apart by biostatisticians and endocrinologists across the U.S. for producing a study which didn’t and couldn’t say what he claimed it did; but the criticism was coded in the language of statistics: it was virtually uninterpretable to journalists covering the controversy (who do an excellent job of appearing  to know nothing about statistics to begin with), and so the public never got the message. Instead they heard Nissen declare that the toll from Avandia worse than 9/11. That’s the message they got, not that his math and methodology didn’t add up.

And so, when the Food and Drug Administration voted against giving Avandia a black box warning, the decision, instead of reassuring the public, suggested that the FDA was incapable of regulating dangerous drugs.

Unfortunately, the mass media is unlikely to get better at covering science anytime soon; in fact, it’s much more likely to get worse, as experienced journalists retire or are forced to produce news with ever decreasing amounts of reporting, and young journalists, pressured by time, effectively take dictation from press releases and activists. The loudest person shouting in a public event is often a crank, and it’s no different with science and public policy. Problem is they make news – and they make great news stories if they also happen to have a Ph.D.

This  journalistic principle that what’s new is news usually takes precedence over what, in fact, is true.  As long as  someone is found to give a “balancing” quote, the story is journalistically kosher for publication. This is *not* how science determines what is true. A new study with a dramatic finding has to be replicated before it gains credence, which is why scientific truth always leans on the existing weight of evidence and gives that precedence. In other words, the scientific narrative is always disposed to what is old and replicable, not to what is new and not yet replicated. This means that journalism and science are often opposed; their respective narratives look at new information in distinctly different ways. A scientist is unlikely to change his or her view based on one new study; but a journalist is far more likely to report what is new and treat the narrative in a way that gives precedence to the new rather than the existing body of research. Meanwhile, the public, fed new findings each day, reads only that this is what “science says” or scientists “say.”

And this is why scientists, or more aptly, the bodies that represent science – the National Academies, the Institute of Medicine, the National Institutes of Health -  need to not only,  as the Financial Times put it, ” speak out quickly and firmly when reason is under attack,” but to explain the reasoning behind good and bad science.

A pox on pox parties

Once upon a time, pox parties – where children were introduced to other children infected with chickenpox – were a logical way of trying to stimulate immunity to the virus in the absence of a vaccine. As epidemiologist Tara C. Smith noted on her blog Aetiology, “Chickenpox ‘parties’ were deemed a better alternative to potentially encountering the disease as an adult–when the frequency of serious complications is higher. Today, however, that just ain’t so.”

But the prevalence of “vaccineophobia” among many parents,  due to all manner of concerns, has spread to the chickenpox vaccine. And now, according to the New York Post’s Page Six magazine , “A growing number of New York parents are scheduling chicken pox playdates where kids share lollipops and trade germy pajamas to spread the disease and avoid vaccinations.”

The Post asks whether this is “an ill-advised idea?” But it’s attempt at providing balance between the anti-vaccine parents’ perspective and the “mainstream” medical perspective illustrates a thorny problem for journalists: how do you report on a contentious health issue affecting children that appears to pit increasing numbers of parents against the medical community?

The problem with reporting both sides and leaving it up to the reader to decide what to make of their respective claims is that clear distinctions between testable scientific proof and non-scientific or pseudoscientific opinion can be blurred in the interests of fairness.  The parents all get to say why they think vaccination is wrong; the doctors all say the parents are wrong; and the journalist steps back from the fray as if both perspectives were equally right. The problem is that they’re not equally scientific. A parent who has done research on the internet isn’t speaking the same language as  someone who has been through medical school, knows how to think through statistical data, or has done years of research in a laboratory. Take the following paragraph from the Post story:

“In the last two decades, rising rates of autism have been loosely linked to vaccines and over the past few years, more and more parents have turned into anti-vaccine public crusaders. Boldfacers like Robert Kennedy Jr. and actress Jenny McCarthy (whose son, Evan, 6, was diagnosed with autism) warn against possible dangers of vaccinations, although the mainstream medical community insists there is no link to autism.”

What, to the reader who doesn’t have a background in statistics or science, does “loosely linked” mean? It suggests that there might be a link even though any correlation between rising autism rates and vaccination can’t demonstrate causation, and has, in fact, been shown to be a product of changes in the way autism has been diagnosed and reported.

Meanwhile, public statements by Jenny McCarthy suggest that she doesn’t understand basic textbook science, and that Robert Kennedy Jr.’s investigation into the suppression of data on the risks of the MMR vaccine demonstrated that he could neither report accurately or fairly nor understand basic science either.

The Post, on the other hand, says mainstream medicine “insists” that there is no link to autism. Actually, it has demonstrated that there is no link to autism through a series of  rigorous studies. Again, the subtle  inflection suggests that there are two bodies of commensurable knowledge in conflict and that the reporter cannot take sides in interpreting one to be superior to the other. False equivalence is even more exaggerated in the following extract:

Upstater Ingrid Johanns, 34, is the former CEO of Affinity Neighborhoods, a real estate investment company. After extensive research, she has decided not to give her  ½-year-old son any vaccines. She, like a number of parents, is convinced there must be a link between vaccines and autism and has shared this belief on an NYC Craigslist forum.

“In the past, we only gave kids a few shots [for deadly diseases like mumps and measles]. Now [doctors] recommend so many. Most children’s bodies can handle that much toxicity, but for others, it does damage—possibly permanent damage,” Ingrid explains. (Although the main worry among parents like Ingrid is autism, critics have blamed vaccines for everything from ADHD to asthma.) “I would rather take the risk of my child contracting measles than autism. The fact that chicken pox has been added to the list of recommended vaccines required truly astounds me.”

Dr. Gershon assures parents that there has been no credible research linking autism to vaccinations. “But it’s very hard to prove that something doesn’t happen, so that’s why it has continued to be questioned,” she says. Although not even all doctors agree on the chicken pox vaccine, she adds that the varicella vaccine is one of the safest available. And it has a big advantage: While 30 percent of people who get pox naturally have the virus reactivated as shingles, the varicella vaccine lessens the risk of that too. Dr. Gershon says that a lot of the doubt over the vaccine comes from the time when kids were required to get just one dose—in about 15 to 20 percent of cases, the vaccine didn’t take. The Centers for Disease Control and Prevention recommends a first dose after 12 months and the second between ages 4 and 6, so “now we give two shots to everybody,” she says. “The immunity appears to persist.”

Now consider what is being said by the way the quotes have been arranged and framed.  A CEO of a real estate company  has done “extensive research” and determined that children can’t withstand the toxic overload from vaccines, and that it astounds her that doctors recommend children get vaccinated against chickenpox.

Here are the questions the journalist should have considered: what does it mean to tell a reader that someone, who isn’t a medical expert and appears to have no medical or scientific training, has done “extensive research?” Does this mean simply surfing the internet – and if so why should the opinion derived from that “research”  be given equal or greater weight to the knowledge of doctors, research scientists, epidemiologists or biostatisticians?

To be fair, the Post then turns to Dr. Anne Gershon, professor of pediatrics at Columbia University and president of the Infectious Disease Society of America, to put the scientific case. But mainstream medicine is on the defensive – and suddenly has its authority undercut  by the Post  turning to a homeopath:

But Dr. Lauri Grossman, a professor at the American Medical College of Homeopathy, says the varicella vaccine can be skipped. “For eons, people have had chicken pox and survived. The immune system gets stronger by having had the virus and establishing a response to it,” she explains.”

While many people are devotees of homeopathy,   it’s not exactly clear why Dr. Grossman, who treats people for physical complaints and emotional disturbances, should have a special insight on infectious diseases, other than to make the general case for alternative medicine.  She doesn’t appear to have  trained as an actual MD.

The bigger problem is that homeopathy has been extensively studied and found to be no better than a placebo; its claims that water has memory are undemonstrable; and we many of its practitioners  have been exposed as offering really bad advice for basic health risks (A BBC investigation found many homeopaths dispensing deadly recommendations on protecting against malaria to those visiting sub-Saharan Africa). But the biggest problem with Dr. Grossman’s challenge to Dr. Gershon is that doing nothing about chickenpox will, at some point, run up against statistics. While many children can shrug off chickenpox as an unpleasant but not especially bad experience, for some, the virus will prove to be rather more traumatic. As one poster noted in a discussion about chickenpox vaccination on scienceblogs:

As for “a few pox” – the daughter of a friend of mine spent 6 weeks in a hospital with osteomyelitis due to chicken pox, 4 weeks on IV antibiotics. It wasn’t clear whether she would keep her leg (she did, luckily) – the scars were their smallest worry.

The daughter of an acquaintance had a varicella stroke.

The daugther of another friend had literally over 1000 pox *everywhere* (including in her vagina, in her throat, her ear canals, under her eyelids). She could not eat and hardly drink for 2 weeks. Granted, the scars are ugly, too, but compared to the 2 week ordeal, they are no issue.

A playmate of my son spent a week in the hospital due to seizures with chicken pox.

And of course, one child in 50,o00 who develops chickenpox will die from encephalitis (during the 1990s, and before widespread vaccination, there was an average of 145 chickenpox-related deaths in the United States each year).  The Post ended with a comment from one parent – “Angie”  whose child finally managed to acquire the virus through a pox party in New Jersey.

It wasn’t exactly fun watching her be so uncomfortable,” Angie says. “But I just felt hugely relieved we wouldn’t have to get the shot.” Of course, she immediately sent an e-mail to friends and family. This time, the pox party was at her place.”

One might ask how long will it be before the media run a story about a child who dies from attending a pox party; if stories about this practice prompt more parents to take the advice of other parents as being equal to that of  the medical community, it will only be a matter of time.*

*One recent comment posted at the end of the article, in fact, mentions such an occurence.

Scorching attack on Wall Street Journal’s anti-FDA bias; group releases full transcript of interview

The Center for Medicine in the Public Interest has published a toe-curling criticism of the way the Wall Street Journal is covering the Food and Drug Administration, specifically the paper’s attempt to portray Dr. Janet Woodcock, who heads the Center for Drug Evaluation and Research, as a megalomaniac who believes herself to be on a par with Ghandi. Here’s how the story by Alice Mundy begins:

“At a recent retreat for Food and Drug Administration employees, a slide show likened the agency’s top drug regulator, Janet Woodcock, to “visionary leaders” such as Golda Meir and Gandhi.

Some lawmakers are fuming about a $1.5 million contract for morale-boosting that the FDA awarded the consultant that prepared the slideshow. The agency’s problems, including questions about decisions on the safety of some popular medicines, are likely to come up in Senate confirmation hearings starting Thursday on Tom Daschle’s nomination to be secretary of Health and Human Services.”

As part of her story, which broadly suggested that the FDA was not responding adequately to numerous “crises” over drug safety,  Mundy interviewed Dr. John Jenkins, the FDA’s director of the Office of New Drugs, who said that the slide was to inject humor into the discussion but that Woodcock was seen as a visionary by many people.

Overall, Mundy’s story was hardly suggestive of probity or effectiveness at the FDA. The question that CMPI raises is whether Mundy’s account is fair or even credible – and it plays something of an ace when it publishes the full transcript of Mundy’s interview with Dr. Jenkins.  Let’s just say that the two-day meeting takes on a different complexion when Dr. Jenkins explains it in detail – in fact, it looks just like the kind of managerial intervention and oversight that would be applauded in any other business field. At the very least it suggests that there’s a different  (but less obviously newsy and scandalous) story to be told.

The disconnect is a reminder that doctors, scientists, and government regulators should ALWAYS record their interviews with journalists – and quickly publish them when they find themselves being selectively quoted.

Why you should learn to love maths

In a new survey of the best and worst jobs by CareerCast.com, the numbers add up to a trifecta for math: the top three rated jobs are, in ascending order, statistician, actuary and, mathematician.

Indeed, it is inarguable that math-skills dominate the top ten list, with biologist, software engineer, and computer systems analyst occupying the fourth, fifth and sixth slots and accountancy the tenth.

In an interesting commentary on the findings in the Wall Street Journal, the reasons behind the triumph of math-related work include the calming effect of problem solving, general low stress, the ability to work from home (which translates into not having to work in unpleasant conditions), and good pay.

Being a lumberjack was rated as the worst job for reasons of danger, poor pay, and no real opportunity for career progression; still, the Journal managed to find a lumberjack to counter the findings:

“It’s a very rewarding job, especially at the end of the day when you see the work you accomplished,” he says. Mr. Nellans, 35, didn’t become discouraged even after he accidentally knocked down a dead tree and broke his right leg in the process four years ago. “I was back in the woods cutting timber in five weeks,” he says.

Love everlasting is all about reward

A stimulating look at sappy media accounts of the latest in MRI image research on how romantic love activates the brain’s reward system. The big question, says Jake Young, is how the reward changes… and that’s something the study doesn’t appear to have measured: more.

The obesity wars: “gooditives” and poems versus dodgy statistics and animation!

In what must count as a spectacularly  ill-judged public relations exercise by the potato chip industry, the European Snack Association suggested that a 30g bag of chips was as nutritious as an apple (if you ignore all that pesky fat).

“Chips… are also a rich source of dietary fibre, provide some important vitamins and minerals….Many people believe that chips are unhealthy because they are processed and contain high fat and sodium (salt). Despite their salty taste, chips contain less salt per gram than bread and many popular breakfast cereals. Frequently an apple is perceived as being healthier alternative because it is natural, unprocessed and rich in vitamins and minerals. In the table below a comparison is made between the nutrient content of a 30g bag of chips and an apple. As you can see the bag of chips provides from twice to thirty times as much of all the vitamins and minerals, three times as much energy, more fibre and complex carbohydrate.  So how do you define a healthier food – one that is nutritionally inferior?”

The problem is that this message was apparently aimed at children in Britain, through nutritional teaching packs sent to schools.  It was caught by The Children’s Food Campaign, which released a report – “Through the Backdoor” – on how the food industry in Britain was engaged in a dodgy educational  campaign that looked a lot more  like a blatant marketing blitz (soft drinks contained “gooditives” rather than additives, and one company encouraged kids to write poems in praise of its sugary, purple drink “Vimto” for National Poetry Day – “schlurple the purple” being more exhortation than lyric). The group complained that the messages in these advertorials would not past regulatory muster on television or in print. As the Children’s Food Campaign press release notes:

“We were flabbergasted by some of the claims in these packs,” said Campaign Coordinator Richard Watts. “We found nutrition lesson plans about the benefits of eating crisps, claiming that colourings in fizzy drinks were to restore the fruit’s natural colour, and telling children to only eat fruit and vegetables in moderation. Promoting junk food in the classroom under the guise of education is unacceptable.”

The idea that children should eat vegetables in moderation and replace them with snacks enhanced with “gooditives” was manna from heaven to the British press – “Firms ‘peddling junk food propaganda’ in our schools, report finds,” proclaimed the Daily Mail; but it also fed the fury of government, which warned that it might ban high fat processed foods as part of a new health campaign promoting a “lifestyle revolution for every family.”

According to the most recent British government statistics, 14.3 percent of school children were overweight and 18.3 percent were obese.

Health Minister Ben Bradshaw told BBC Radio 4′s leading news radio program Today  that action was needed because “if we don’t do anything, on current projections, nine out of 10 of today’s children will be obese when they are adults.”  So staggering was the statistic that the Today show anchor asked the minister to repeat it, which he did, thereby driving home the scale of the problem with measurement. After all, if you can’t measure a problem, how can you fix it?

The statistic also shows up in a major advertising campaign created by M&C Saatchi and the Oscar-winning creators of Wallace and Gromit, Aardman Animations. (Note that the ad doesn’t mention the word obese or obesity.)

But the projection is as spurious as the claims about “gooditives.” It’s based on an assumption that the increases seen in obesity in the past will continue at a constant rate in the future, independent of any other factors, such as genetics or diet or lifestyle habits.  And that, frankly, is a bit hard to swallow.

The British government appears to be following research published in the U.S.  in the July 2008 issue of the  journal Obesity: namely, that almost nine out of every ten Americans will be overweight or obese by 2030. But in order for this projection to be realized one would have to accept that some people are not genetically disposed to be thin, that most people will not engage in sport or exercise or manual labor of any kind and that at the same time most people will eat significantly more than their calorific requirements on a regular basis.

The absurdity of this projection is that eventually, if current rates of increase continue, everyone will be obese.