Tag: medicine

My letter to the BMJ regarding their lax editorial approach to bogus therapy paper

Here it is. I think it is pretty self-explanatory (nonetheless, I have added some additional context below the fold):

Date: Sep 11, 2019
To: <Fiona Godlee>, Editor in Chief, BMJ

RE: BMJ’s scientifically and ethically indefensible decision about Bristol’s Lightning Process study

Dear Dr Godlee,

First of all, thank you for the work that you do as editor in chief of the BMJ. I do not at all mean this as faint praise. While my colleagues and I have expressed our concerns, I believe it is important to note that editing a journal is not always easy. Editors play a crucial part in the production line of science and your own contributions, and those of your editorial colleagues, need to be acknowledged.

Secondly, I feel obliged to add my voice to those others who have written to you about the paper “Clinical and cost-effectiveness of the Lightning Process in addition to specialist medical care for paediatric chronic fatigue syndrome: randomised controlled trial” and, particularly, the associated correction that was published.

You will be familiar with the details of our concerns as outlined in previous emails.

From my own perspective, I have been investigating the issues around controversial therapies and human factors (i.e., error risks) in research for nearly two decades. You will be aware that expectancy effects and confirmation biases are very problematic in clinical therapy research in general. They create particular chaos with therapies that are controversial to begin with.

The so-called ‘Lightning Process’ is undoubtedly one such therapy. In fact, it comprises a number of modalities that are normally classified as pseudosciences. It is based largely on so-called Neuro-Linguistic Programming (NLP), which is a completely discredited practice. The creator of the ‘Lightning Process’ is an advocate and provider of several pseudoscientific therapies (e.g., cranial osteopathy; applied kinesiology; hypnotherapy). All told, there is nothing to suggest that the ‘Lightning Process’ is a promising clinical modality. It has no scientific plausibility; it exists because commercially-minded providers of pseudoscientific treatments have successfully identified a market for it. In that regard, it occupies the same space as, say, crystal therapy.

In offering that description, I do not intend to be pejorative. I merely wish to point out that any hypothesis that the ‘Lightning Process’ is effective for any condition constitutes an “extraordinary claim.” By all means should extraordinary claims be tested. Studies of crystal therapy, for example, should be conducted. However, you will appreciate that in science, “extraordinary claims require extraordinary evidence.” Research purporting to establish the efficacy of the ‘Lightning Process’ needs to exhibit a truly compelling evidentiary standard. The claims made inherently challenge our mainstream understanding of human biology. If the ‘Lightning Process’ is in fact shown to work, we will need to re-write our physiology and neurology textbooks.

On the face of it, the evidence contained in this particular paper is far from extraordinary. In fact, as per your own published correction, the study bypassed the normal requirement for prospective registration. This immediately raises the red flag of reporting bias. The evidence accrued from the paper cannot be relied upon because the authors were able to select to report it, without pre-registering their intentions.

In short, confirmation bias was not prevented. Your request to the authors that they tell you whether or not they were biased is very insufficient.

The data produced in light of this procedural and methodological lapse by no means meet the standard of “extraordinary evidence”.

As I understand it, this paper would not have been published had you known about its irregularity at the time of initial review. Therefore it should not be published now. Therefore it should be retracted.

A serious problem with not retracting this paper is that its existence will strongly encourage other researchers to play fast and loose with pre-registration, in the knowledge that their findings can still be published in a BMJ journal. The paper will stand as a high-profile exemplar of ambiguous editorial commitment to scientific rigour.

Kind regards,

Professor Brian Hughes, PhD, FPsSI
School of Psychology
National University of Ireland, Galway

For context, my email is part of a now lengthy correspondence following an Open Letter to the BMJ arising from the correction of the ‘Lightning Process’ paper. I was one of several international scientists to co-sign the original letter, which called for the paper to be properly retracted. Afterwards, several individual signatories provided their personal perspectives as I have done above.

It is worth noting that I deliberately focused on the matter of confirmation bias, as it reflected a point that I felt would benefit from greater emphasis and about which I feel well qualified to comment. 

However, there are a number of other problematic issues relating to this paper. These include the very poor methodology employed in the study, where (again) self-report methods are relied upon in the absence of adequate blinding in a clinical trial. This makes the study wholly unreliable, and raises questions about the quality of peer review used by the journal.

In short, why exactly did the journal fail to pick up on such an elementary methodological weakness?

People will have varying opinions about why this happens so frequently. I have written before about how some fields come to be characterised by mass incestuous deference to eminent researchers and their acolytes, and about how unpoliced pandering frequently diminishes the quality of science by neutering peer review. 

I suspect I will need to write about that issue again…

…and again…

and again.

For those interested, you can find out more information about the so-called ‘Lightning Process’ here

Begging-the-question, conjecture, anecdote, false equivalence, and a non sequitur: those five reasons for raising the Digital Age of Consent

Cormac Ryan has been tweeting about the Royal College of Physicians of Ireland and their letter to the government on the Digital Age of Consent.

Cormac is right. The letter really is absurd.

The RCPI Faculty of Paediatrics wants the Digital Age of Consent to be 16 years, but the government want it to be 13 years. So on the face of it we have a dispute.

On one side we have trained medical professionals who specialize in children’s health and well-being. On the other side are a bunch of bean-counters, bureaucrats, and gombeen-politicians looking for a quick-fix won’t-somebody-please-think-of-the-children solution to the latest moral panic.

It’s a mismatch, right? How can the medics lose this argument?

Well…here’s how.

 

The RCPI offer five reasons “to support the digital age of consent being set at the higher limit of 16 years”. Five reasons sounds like a lot of reasons.

Here, in turn, are each of them:

1. Child Protection: Paediatricians in Ireland, particularly those specialising in child protection and child sexual abuse, are concerned about the recent reports of children being groomed on line increasing the risk of child sexual abuse.

Translation: Hmmm. The RCPI’s first “reason” seems to simply be that “paediatricians are concerned”. This reason itself requires a reason. Why are they concerned?

In other words, this reason is not actually a reason at all.

2. Comprehension of risks: It is recognised in the GDPR that children and teenagers merit special protection regarding their personal data; a child may lack comprehension of the significant risks and consequences of sharing personal data, including photographs. Similarly, children may not have the judgement/maturity to understand the consequences of inappropriate disclosure of feelings and personal thoughts on the internet. This behaviour may lead to significant feelings of regret, worry and anxiety.

Translation: Children “may” lack comprehension. Children “may” not be able to understand. This “may” lead to anxiety. Or…drum roll…maybe not.

Note that there is no mention here of evidence that might augment this string of maybes, just some hand-waving about “it” being “recognised”. “It” is simply conjecture. The “recogniser” remains anonymous.

Again, this reason is not a reason.

3. Mental health and wellbeing: Concern is rising as evidence is emerging of the negative impact that the use of electronic devices may be having on the mental health of children and young people. Teachers, GPs, paediatricians and psychiatrists are seeing children presenting in increasing numbers with anxiety, sleep deprivation, mood disturbances reported to be related to social media use. There is now much anecdotal evidence that on-line bullying may have a role in self-harming and suicide in our young people.

 

Translation: Here the RCPI tell us that there is “evidence” that electronic devices “may” (again with the maybes) be bad. And what is this evidence, we might ask?

Well, we are told that the evidence comes from “teachers, GPs, paediatricians, and psychiatrists”. That sounds a lot like anecdotal evidence.

The RCPI are not shy to own up. They indeed agree that this evidence, so-called, is in fact “anecdotal”. But they seem to think this is a good thing, because there is “much” of it.

On the basis that I can provide you with (“much”) anecdotal evidence that the Loch Ness Monster exists, I must point out that “anecdotal” evidence is not really evidence at all. The mere concept of “anecdotal evidence” is an oxymoron, utterly unscientific, and a poor camouflage for incoherence.

Once again, therefore, this reason is not a reason.

4. Medical age of consent: Sixteen years is in line with the minimum age at which a child may consent to medical treatment.

Translation: Here the RCPI assert that the digital age of consent should be the same as the age of consent for medical treatment. But — and surely this is obvious — surfing the web or maintaining a social media account is not medical treatment. Why should the age of consent be the same?

The age of consent for sex in Ireland is 17. The ‘age of consent’ for smoking (although it is not really called that) is 18. The minimum age for standing for parliament is 21. The minimum age to run for president is 35.

You can legally start working a full-time job at 14. The legal age at which you can steer a boat is 13. The age at which you can be charged with murder (or rape) is 10. There is no legal minimum age for getting a body piercing or a tattoo.

Why should the Digital Age of Consent be higher than the age at which the state allows you to have a full-time job, to be charged with serious crime, or to get your nipples pierced?

Or why should you be considered too young to watch Peppa Pig on YouTube, but old enough to have an image of Peppa Pig tattooed across your buttocks?

The answer of course is that there is no logic here. It is simply arbitrary of the RCPI to link one age of consent with another. It is a selective rationale designed to corroborate a subjective point of view.

In other words, once more, this reason is not a reason.

5. Supporting Parents: Parents need to be supported in their efforts to educate, guide and monitor their children’s use of the internet and setting the age at 16 will affirm parents in their role and the need to assess their own child’s maturity and judgement.

Translation: This is possibly the most incoherent of all the reasons put forward in the RCPI letter. It effectively equates to the following — “The Digital Age of Consent should be 16 because, er, this will help parents“. But why exactly is this the case? Why would 16 help parents more than 13, or 18, or 10, or 21?

Yet again, THIS REASON IS NOT A REASON!

And that, ladies and gentlemen, is the sum total of what the RCPI have to offer. That’s the lot. Five so-called reasons for raising the Digital Age of Consent — begging-the-question, conjecture, anecdote, false equivalence, and a non sequitur.

We might expect such a milieu of nonsense from a group of Luddites, or anti-vaxxers, or all-round anti-tech hystericals, and for sure there is always plenty of specious stuff submitted to government on this and many other issues when open calls are made.

But this is the Royal College of Physicians, for goodness sake. I thought these folks were supposed to be empirical scientists. Something very weird is happening here.

Won’t somebody please get these people a tablet…

The homeopathic drugs DO work. Because they’re drugs

homeopathicdrugs

So, how can it be that homeopathy sometimes seems to work? Well there are a few possible explanations:

  1. The universe is broken
  2. Placebo etc.
  3. They’re cutting the stuff with real penicillin

Full marks to those of you who selected #3. Because, that’s right, it’s yet another example of alternative drug pushers contaminating their products with undeclared industrial additives. Continue reading “The homeopathic drugs DO work. Because they’re drugs”

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