vrijdag 23 november 2012

Bad Science - Ben Goldacre [2]



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A landmark meta-analysis was published recently in the Lancet. It was accompanied by an editorial titled: ‘The End of Homeopathy?’ Shang et al. did a very thorough meta-analysis of a vast number of homeopathy trials, and they found, overall, adding them all up, that homeopathy performs no better than placebo. The homeopaths were up in arms. If you mention this meta-analysis, they will try to tell you that it was a stitch-up. What Shang et al. did, essentially, like all the previous negative meta-analyses of homeopathy, was to exclude the poorer-quality trials from their analysis. Homeopaths like to pick out the trials that give them the answer that they want to hear, and ignore the rest, a practice called ‘cherry-picking’. 

But you can also cherry-pick your favourite meta-analyses, or misrepresent them. Shang et al. was only the latest in a long string of meta-analyses to show that homeopathy performs no better than placebo. What is truly amazing to me is that despite the negative results of these meta-analyses, homeopaths have continued—right to the top of the profession—to claim that these same meta-analyses support the use of homeopathy. They do this by quoting only the result for all trials included in each meta-analysis. This figure includes all of the poorer-quality trials. The most reliable figure, you now know, is for the restricted pool of the most ‘fair tests’, and when you look at those, homeopathy performs no better than placebo. 

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in most cases today it is considered wrong even to use a placebo in a trial: whenever possible you should compare your new treatment against the best pre-existing, current treatment. This is not just for ethical reasons (although it is enshrined in the Declaration of Helsinki, the international ethics bible). Placebo-controlled trials are also frowned upon by the evidence-based medicine community, because they know it’s an easy way to cook the books and get easy positive trial data to support your company’s big new investment. In the real world of clinical practice, patients and doctors aren’t so interested in whether a new drug works better than nothing, they’re interested in whether it works better than the best treatment they already have. 

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And now, at last, we come to the lowest point of this whole story, not merely for Matthias Rath’s movement, but for the alternative therapy movement around the world as a whole. In 2007, with a huge public flourish, to great media coverage, Rath’s former employee Anthony Brink filed a formal complaint against Zackie Achmat, the head of the TAC. Bizarrely, he filed this complaint with the International Criminal Court at The Hague, accusing Achmat of genocide for successfully campaigning to get access to HIV drugs for the people of South Africa. It’s hard to explain just how influential the ‘AIDS dissidents’ are in South Africa. 

Brink is a barrister, a man with important friends, and his accusations were reported in the national news media—and in some corners of the Western gay press—as a serious news story. I do not believe that any one of those journalists who reported on it can possibly have read Brink’s indictment to the end. I have. The first fifty-seven pages present familiar anti-medication and ‘AIDS-dissident’ material. But then, on page fifty-eight, this ‘indictment’ document suddenly deteriorates into something altogether more vicious and unhinged, as Brink sets out what he believes would be an appropriate punishment for Zackie. Because I do not wish to be accused of selective editing, I will now reproduce for you that entire section, unedited, so you can see and feel it for yourself. 

“APPROPRIATE CRIMINAL SANCTION In view of the scale and gravity of Achmat’s crime and his direct personal criminal culpability for ‘the deaths of thousands of people’, to quote his own words, it is respectfully submitted that the International Criminal Court ought to impose on him the highest sentence provided by Article 77.1(b) of the Rome Statute, namely to permanent confinement in a small white steel and concrete cage, bright fluorescent light on all the time to keep an eye on him, his warders putting him out only to work every day in the prison garden to cultivate nutrient-rich vegetables, including when it’s raining. In order for him to repay his debt to society, with the ARVs he claims to take administered daily under close medical watch at the full prescribed dose, morning noon and night, without interruption, to prevent him faking that he’s being treatment compliant, pushed if necessary down his forced-open gullet with a finger, or, if he bites, kicks and screams too much, dripped into his arm after he’s been restrained on a gurney with cable ties around his ankles, wrists and neck, until he gives up the ghost on them, so as to eradicate this foulest, most loathsome, unscrupulous and malevolent blight on the human race, who has plagued and poisoned the people of South Africa, mostly black, mostly poor, for nearly a decade now, since the day he and his TAC first hit the scene."

Signed at Cape Town, South Africa, on 1 January 2007 Anthony Brink 

The document was described by the Rath Foundation as ‘entirely valid and long overdue’. This story isn’t about Matthias Rath, or Anthony Brink, or Zackie Achmat, or even South Africa. It is about the culture of how ideas work, and how that can break down. Doctors criticise other doctors, academics criticise academics, politicians criticise politicians: that’s normal and healthy, it’s how ideas improve. Matthias Rath is an alternative therapist, made in Europe. He is every bit the same as the British operators that we have seen in this book. He is from their world. Despite the extremes of this case, not one single alternative therapist or nutritionist, anywhere in the world, has stood up to criticise any single aspect of the activities of Matthias Rath and his colleagues. In fact, far from it: he continues to be fêted to this day. I have sat in true astonishment and watched leading figures of the UK’s alternative therapy movement applaud Matthias Rath at a public lecture (I have it on video, just in case there’s any doubt). 

Natural health organisations continue to defend Rath. Homeopaths’ mailouts continue to promote his work. The British Association of Nutritional Therapists has been invited to comment by bloggers, but declined. Most, when challenged, will dissemble. ‘Oh,’ they say, ‘I don’t really know much about it.’ Not one person will step forward and dissent. The alternative therapy movement as a whole has demonstrated itself to be so dangerously, systemically incapable of critical self-appraisal that it cannot step up even in a case like that of Rath: in that count I include tens of thousands of practitioners, writers, administrators and more. This is how ideas go badly wrong. In the conclusion to this book, written before I was able to include this chapter, I will argue that the biggest dangers posed by the material we have covered are cultural and intellectual. I may be mistaken.

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