Tuesday, 12 November 2013

Mad Mel and the MMR crusade

I actually wrote the below years ago for uni, but just came across it while trawling through old files on my laptop and thought it appropriate to the topic of my blog, so thought I'd add it. It's certainly the most fun I've ever had writing an essay for education purposes.
In her 2003 Daily Mail article, entitled ‘MMR: The truth’, Melanie Phillips claims to offer the public the facts regarding the MMR vaccination scare, which started with the publication of a 1998 research paper by Andrew Wakefield and colleagues at the Royal Free Hospital and School of Medicine in Hampstead, London. However, within the first few lines of the article, she has already set the tone of the story, describing Mr Wakefield as an “outcast and an enemy” who has been “driven from his job” by the scientific establishment. The use of such language immediately evokes an emotional response aimed at creating a feeling of sympathy for Wakefield, before presenting any facts, whether against or in defence of his claims. Shortly afterwards, Miss Phillips claims Wakefield’s detractors were “allegedly bribed or threatened not to have anything to do with him” – a claim she does not substantiate anywhere in her article, but which further creates the impression that Wakefield is the victim of a global conspiracy.

Her attempt to evoke an emotional response continue in parts two and three of the investigation, where she interviews the parents of a number of autistic children who allegedly began to display symptoms of the disease shortly after vaccination. Use of descriptions such as “a bubbly and jolly baby” and “bright as a button”, followed by accounts of the children’s parents’ observations of how their development regressed, resulting in terrible symptoms, constitute anecdotal evidence at best, but they further create bias against the ‘callous’ establishment that continues to deny that MMR can have devastating consequences.

Another method used by Phillips to create bias in favour of Mr Wakefield’s claims is the misrepresenting of a report on the safety and continued use of the vaccine. She quotes a report by the Institute of Medicine of the National Academies (wrongly called the ‘American Institute of Medicine’ in the article), claiming that the report found that evidence from a booster would constitute a strong case that the vaccine and the symptoms ascribed to it were linked”. Although the report’s authors may have made that point, the conclusion of the report actually stated that, while more research was needed, “The evidence favours rejection of a causal relationship at the population level between MMR vaccine and autistic spectrum disorders.” (IOM 2001) Then, in part three of her article, Phillips explains the UK Department of Health’s defence of the MMR vaccine by revealing that the government of Japan decided to abolish the polyvalent vaccine in 1993 after the Urabe strain of mumps in the vaccine caused an outbreak of aseptic meningitis, adding that the DoH had by then already removed vaccines containing this strain, but immediately pointing out that the department had knowledge of the risks when it introduced the vaccine. She does not mention that Japan’s government is planning to reintroduce a polyvalent vaccine to replace the single jabs it has used since 1993. In addition, a study published two years after Melanie Phillips’ article found that autism rates in Japan have continued to rise since the abolition of MMR, offering evidence against a link between the two.  (Honda et al 2005)

Despite the fact that the overwhelming majority of scientists and doctors have dismissed the claims made by Andrew Wakefield, Phillips cites only two such figures; child psychiatrist Dr Patrick Bolton and fellow autism expert Dr Eric Fombonne. However, she is quick to point out that the latter is “advising the drug companies that make MMR” in an attempt to discredit him. Meanwhile, claims to provide evidence that “utterly inconclusive studies” have been used as proof that MMR is safe, but fails to cite any studies – whether supporting or contradicting her claims.

Finally, the article repeatedly claims that those critical of Andrew Wakefield’s research are paid by the pharmaceutical industry to claim MMR is safe, but it fails to provide any proof of these allegations. Furthermore, Phillips does not appear to have investigated the conduct of Wakefield himself, who later faced claims of misconduct and fraud together with two of his colleagues, nor does she mention the decision of the majority of co-authors of his paper to retract their support for its findings. An investigation published in The Sunday Times a year after the Daily Mail article revealed that Wakefield himself had a conflict of interest regarding the publication of the paper, having submitted a patent application for a new measles vaccine in 1997. (Deer 2004) This investigation also claimed that Wakefield had falsified data, and ultimately led to legal proceedings which saw him banned from practising medicine in the UK.


In 1998, The Lancet published a report, created by Andrew Wakefield and his team at the Royal Free Hospital and School of Medicine in north London, describing a one-week research project involving 12 children between the ages of three and ten, all of whom had been referred to the unit after suffering a regression in development, combined with symptoms such as diarrhoea and abdominal pain. (Wakefield et al 1998) In eight of the cases, the parents or the child’s GP had identified the MMR vaccine as a possible cause; in one case measles was identified, in another otitis media, and in two cases no link was established prior to admission. Neuropsychiatric diagnosis was autism in ten cases, post-viral encephalitis in one case and post-vaccinial encephalitis in another. After carrying out a range of tests over a period of one week, the team concluded that:

Intestinal and behavioural pathologies may have occurred together by chance, reflecting a selection bias in a self-referred group; however, the uniformity of the intestinal pathological changes and the fact that previous studies have found intestinal dysfunction in children with autistic-spectrum disorders, suggests that the connection is real and reflects a unique disease process. (Wakefield et al 1998)

Prior to publication of the report, senior scientific investigator Andrew Wakefield arranged a press conference, during which he called for the suspension of the MMR vaccine pending further research, warning that it appeared the vaccine could cause autism and bowel disease in a small percentage of recipients. His comments made headlines in the UK and abroad, and led to widespread concerns and a fall in uptake of the vaccine. However, no study in the 14 years since the report’s publication has been able to replicate Mr Wakefield’s results, and epidemiological studies have consistently reported no evidence for a link between MMR and autism.

In 2000, the Pediatric Infectious Disease Journal published an epidemiological study conducted in Finland. (Patja et al 2000) The study analysed data from hospitals and health centres throughout Finland concerning adverse effects reported in children who had received the MMR vaccine between 1982 and 1996. Over this period, 1.8m individuals were given a total of three million MMR vaccinations, resulting in reports of 173 alleged potentially serious reactions. These included 77 neurologic reactions – however, 45pc of the total number of reactions were later “proved to be probably caused or contributed by another factor.” (Patja et al 2000) Ultimately, the researchers concluded that a link between the vaccine and adverse events cannot be established “solely on the basis of a temporal relation,” and that the risks of natural MMR diseases are far greater than the minimal risks posed by the vaccine.

Five years later, a Japanese team published an epidemiological study which had analysed autism rates in Japan in children up to age seven in the city of Yokohama between 1988 and 1996. (Honda, Shimizu, Rutter 2005) It was reported that between 1988 and 1992, autism rates in the city declined significantly. The last polyvalent MMR vaccine in Japan was given in 1993, and between 1993 and 1996 the rate of ASD was found to have increased significantly. The study’s authors concluded that withdrawal of the MMR vaccine in countries where it was still being used would be unlikely to lead to a reduction in ASD rates.

In 2008, an international team published a report on a study that analysed the presence of measles vaccine (MV) RNA in bowel tissue of children with autism. (Hornig 2008) The study looked at 25 US children with autism and GI disturbances, and another 13 with GI disturbances alone, who served as a control group. The researchers did not discover a difference between the presence of MV RNA in the ileum and cecum, and concluded that this offered evidence against a causal link between exposure to MMR or persistent MV RNA in the GI tract and autism.

In the face of ongoing concerns, the Cochrane Collaboration carried out a meta-analysis of 31 studies into the alleged link between autism and MMR published before 2004. (Demicheli et al 2008) The authors concluded that reporting and design of safety outcomes in MMR vaccine studies are largely inadequate, noting that “The evidence of adverse events following immunisation with MMR cannot be separated from its role in preventing the target diseases.” (Demicheli et al 2008) Analysis of the studies further found that although the MMR vaccine was associated with an increased risk of symptoms including irritability, there did not appear to be a link between the vaccine and Crohn's disease, ulcerative colitis, autism or aseptic meningitis. The authors were not able to identify studies that met their inclusion criteria, which assessed the effectiveness of MMR.


BOSELEY S. (2004) “MMR vaccinations fall to new low.” The Guardian, 24 September 2004 [online]
Available from: http://www.guardian.co.uk/uk/2004/sep/24/society.politics
[Accessed 11 February 2012]

DEER B. (2004) “Revealed: MMR research scandal.” The Sunday Times, 22 February 2004 [online]
Available from: http://briandeer.com/mmr/lancet-deer-1.htm
[Accessed 11 February 2012]

DEMICHELI V. et al (2008) “Vaccines for measles, mumps and rubella in children.” Cochrane Library [online] October
Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004407.pub2/abstract;jsessionid=EE67E616428AAAD01DAC2A21F835158F.d02t02
[Accessed 12 February 2012]

HONDA H., SHIMIZU Y., RUTTER M. (2005) “No effect of MMR withdrawal on the incidence of autism: a total population study.” The Journal of Child Psychology and Psychiatry [online] v.46 (6), June, pp. 572-579
Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2005.01425.x/abstract
[Accessed 11 February 2012)

HORNIG M. et al (2008) “Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study.” PLoS One [online] v. 3 (9), September
Available from: http://www.ncbi.nlm.nih.gov/pmc/
[Accessed 10 February 2012]

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES (2001) Immunisation safety review: Measles-mumps-rubella vaccine and autism (report brief). IOM
Available from: http://www.iom.edu/Reports/2001/Immunization-Safety-Review-Measles-Mumps-Rubella-Vaccine-and-Autism.aspx
[Accessed 10 February 2012]

LAURANCE J. (2008) “Official warning: Measles ‘endemic’ in Britain.” The Independent, 21 June 2008 [online]
Available from: http://www.independent.co.uk/life-style/health-and-families/health-news/official-warning-measles-endemic-in-britain-851584.html
[Accessed 11 February 2012]

PATJA A. et al (2000) “Serious adverse events after measles-mumps-rubella vaccination during a fourteen-year prospective follow-up.” Pediatric Infectious Diseases Journal [online] v. 19 (12), December, pp. 1027-1034
Available at: http://www.nccn.net/~wwithin/MMR.pdf
[Accessed 10 February 2012]

PHILLIPS, M. (2003) “MMR – The truth.” Daily Mail March/April 2003 [online]
Available from: http://www.dailymail.co.uk/health/article-171316/MMR--The-Truth.html, http://www.dailymail.co.uk/health/article-171527/MMR--warnings-ignored.html, http://www.dailymail.co.uk/health/article-171779/MMR-true-facts.html
[Accessed 10 February 2012]

WAKEFIELD, A.J. et al (1998) “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children (retracted).” The Lancet [online] v. 351 (9103), February, pp. 637-641
Available at: www.sciencedirect.com
[Accessed 10 February 2012]

Wednesday, 4 September 2013

A change.

For the past year, I've been volunteering in a hospital one evening a week. Duties mostly involve helping people eat, getting them shopping (let's face it, hospital food isn't going to win any Michelin stars even when the quality is relatively high), patient surveys, and just generally spending time with people. I won't lie - I wasn't motivated by altruism or some deep sense of caring for my fellow human beings; I'm considering applying for medical school in a few years' time, and figured it would look good on my application if I do. Another thing I should admit is that when I started, I expected to hate every moment of it. I don't consider myself a 'people person', and often find it hard enough to be around friends and acquaintances for long periods of time, so being forced to smile and be kind to a bunch of people I don't even know is not my idea of a fun time. (This make it sound like I don't appreciate my friends; that's not the case! Spending much time with others just doesn't come very naturally to me - I blame a childhood that featured plenty of books and no siblings)

But now the end is approaching; tonight was my penultimate shift. To some extent, I've proven myself right: I still feel awkward when I'm asked to just go have a chat with a lonely patient, and can't keep a conversation going to save my life - luckily, in a lot of those cases, the patients themselves just want to have someone to chat to, so it's fairly easy to just sit there and answer their occasional questions. However, in other ways I've surprised myself. Sure, there are some patients I'd rather run away from screaming; recently, a female patient demanded - demanded! - that I go get her some shopping. I was in the middle of helping someone else with their dinner, and at any rate, while I'm happy to go just about anywhere within reason to get what a patient is after, a little appreciation goes a long way. She was still asking for someone to get her things when I went home. But the majority of patients have been lovely.

What I've found most surprising about the experience has been the fact that there have been patients, especially ones I met on a number of occasions, about whose fate I actually started caring. When I started, I'd never anticipated I would feel anything other than complete detachment to these strangers! There was the cancer patient who, the first time I was asked to help her, was too weak even to swallow more than a little jelly, but the last time I saw her (just before she was discharged), almost two months later, happily ate a normal dinner without help. There was also the elderly lady whose trajectory, sadly, went the other way. There was the patient with a brain tumour, whose symptoms meant that she recognised me some weeks but not others.

Spending all this time in a hospital has also greatly increased my appreciation of the work nurses do, by the way - something that is easy to miss when you spend a significant proportion of your professional life reading news about how allegedly lazy and incompetent they all are. They (have to) work incredibly hard and are always busy, but nevertheless they're almost invariably friendly. I suspect that if there is banter, that's just a way to stay sane in what can be a slightly crazy environment. And they're probably working while bantering. Besides, nursing is hardly a career anyone would choose for easy money!

So anyway, I've secretly come to enjoy my three hours a week quite a lot, even if it is sometimes a colossal pain to have to get out of bed extra early because of it. This evening, I found myself in a slightly surreal situation with an erratic patient and a junior doctor. Neither the doctor nor I knew what to do with the situation, but when the patient eventually calmed down, I realised I'm actually going to miss all this - I'm having to quit because this year my shift will clash with uni - and I'm kind of, a little bit, wondering if I could maybe fit in a shift on a different evening.

Who knows, I might turn into a people person after all :)

By the way, I know I've been getting increasingly off-topic lately (and this really is an unusually gushing post, isn't it), but I've come to realise that mocking the Mail/Express's inability to convey even the most basic scientific facts is just too easy. And it gets a little monotonous :)

Saturday, 30 March 2013

The persecuted masses?

I'm veering a little off-topic here, but another article appeared yesterday by someone who seems to have been put on this planet solely to piss off anyone with a grain of sanity within them. If there is a god, he is a vengeful one indeed, for no beneficent god would saddle us with Lord Carey...

Anyway, in yesterday's Daily Mail, Lord Carey had a go at David Cameron. This, I'm generally in support of. The issue however, lies in the fact that he accused the PM of hypocrisy for proclaiming his support for the Christian cause, all the while doing more than any prime minister before him to promote the persecution of Christians. The persecution! I've taken the liberty of lifting the following definition from that Bible of the modern age, Wikipedia:

"Persecution is the systematic mistreatment of an individual or group by another group. The most common forms are religious, ethnic and political persecution, though there is naturally some overlap between these terms. The inflicting of suffering, harassment, isolation, imprisonment, fear, or pain are all factors that may establish persecution. Even so, not all suffering will necessarily establish persecution. The suffering experienced by the victim must be sufficiently severe."

The examples of this alleged 'persecution' given by Carey are the usual suspects: the British Airways worker fired for wearing a crucifix and a campaign 'to turn the parliamentary chapel of St Mary Undercroft into a multi-faith prayer room so gay couples can get married there'. The former would seem a little obsolete considering the European Court of Human Rights has ruled that BA was in the wrong and the airline has long since changed its policy on the wearing of religious jewellery, and the latter... Well, first of all, why should Christian domination trump gay (or for that matter religious) equality? And second of all, London has churches in a greater density than anywhere else in England - if those parliamentary Christians who can't bear praying in the vicinity of people with beliefs other than their own, they wouldn't have to walk far to find a Christian church. I noticed a comment underneath the coverage of his outburst on the BBC website claiming attacks on Christianity in Britain always bring the discussion back to gay marriage - but it would appear the Christian side of the argument can't help bringing it up either!

I wonder how people who face actual persecution would feel about Carey's opinions. Maybe someone could ask the Christians in Pakistan or Iran, who really are prevented from taking on numerous roles in public life and can face threats of prison or even death if they show their faith in public.

Anyway, for those still unsure about whether they face persecution in the UK, the Daily Mash has compiled a handy quiz.

I, and most other non-religious people and secularists I know, are perfectly fine with you practising your faith in private. We don't think you should denied jobs, or any other rights, on the basis of your faith. All we ask is that you don't force us to share your beliefs and let us get on with our own lives, so long as they don't impact on other people's. And let's face it, if you think your heterosexual marriage is diminished by other people's right to marry someone of the same gender as themselves, there are probably some deeper issues to be addressed within your 'holy matrimony'. And if the addition of other faiths to a chapel, or the request to take off a crucifix, somehow diminish your ability to be a Christian, you might want to re-evaluate your relationship with god. I was under the impression faith is in the heart; in that case, surely a piece of jewellery or a piece of real estate aren't necessary to practice your beliefs.

Friday, 1 March 2013

Use more drugs, says drug company

A number of papers reported on a study of breast cancer survival rates in several countries, undertaken by the London School for Hygiene and Tropical Medicine, today. I haven't really looked into that study, mostly because the findings, as reported in the papers, don't sound all that dramatic or surprising. However, presumably because it considered this study not quite dramatic enough, the Daily Mail decided to add reportage of a second study to its story. In the article, Jenny Hope (who else) claimed that British oncologists are guilty of scandalous ageism, because said study has found that the majority of breast cancer patients over the age of 70 aren't offered chemotherapy after surgery. This is, apparently, particularly outrageous because chemotherapy improves the effectiveness of Herceptin, and because a significant part of these women weren't tested for HER2 before it was decided not to offer them chemotherapy.

I have a list of issues with this report roughly as long as my arm, but let's start with the fact that the study was first published more than a month ago. Not usually likely to miss an opportunity for sensationalism, I'm wondering why they're only catching on now? But anyway, that has little to do with the actual content of the report; my other complaints do.

As the Mail clearly states, this study was funded by Roche. You know, that Swiss pharmaceutical giant that produces, among other things, Herceptin and Xeloda, a chemotherapy drug often used in combination with Herceptin. I would've been a bit surprised if a study sponsored by a drug's manufacturer had concluded that more than enough women are being prescribed it... Call me a cynic.

It took a fair bit of trial and error searching, but I've found the original study - well, I found the abstract, because I'm not willing to pay US$32 to read the whole thing, and the day I figure out how to log into PubMed via my uni will be the day I quit my job and devote my life to reading everything written in the scientific literature ever - and I couldn't help but notice that from the first section, the background information, it seems like this study was not so much aimed at finding new information as at making a pre-conceived point:

"As few older women with breast cancer receive adjuvant chemotherapy, we examined the barriers and perceptions of 24 UK NHS multidisciplinary breast cancer teams to offering this treatment to women ≥70 years."

I'm probably biased and therefore might read things into this that aren't there, but to me, the statement that they're searching for 'barriers and perceptions' that stop doctors offering chemotherapy suggests that they'd already decided, before starting the study, that chemo should be offered more frequently. A slightly more 'open' phrasing would have been nice - maybe they could have examined 'if there are barriers to offering this treatment'.

Then, in the results of the abstract, it appears that of the women offered chemotherapy after surgery (14pc of the sample), only just over half decided to undergo it. For those not offered chemo, treatment teams overwhelmingly cited the availability of other treatments, or a lack of expected benefit from chemotherapy, as reasons for not offering it. Considering the study focuses solely on women over 70, surely the cost/benefit analysis should be taken into account before blindly arguing that the uptake of chemo should be improved? These women are likely to have different priorities, and face a different level of risk, than patients in their 40s and 50s. I have no idea whether the full report looks at the stage of cancer at diagnosis - the abstract certainly doesn't mention anything about it - but this would also be an important factor.

The researchers do make a valid point in the fact that the rates of chemotherapy offered to this group of patients varies strongly between health trusts, and this would be an interesting and important issue to look into. Another study I'd like to see would be a ten-year follow up study of breast cancer patients over 70 who have either received chemotherapy or not, in order to compare survival rates. Those figures would be necessary before it can be confidently argued that improving uptake of chemo is a good thing!

So, for a change I spent more time complaining about a study than about the Mail's coverage of it - most unusual, but I'm sure I'll be able to go back to my old ways soon enough...

Thursday, 14 February 2013

Homeopathy, supplements, potato, potato

I'm back! It's been a busy couple of months and spending writing anything that wasn't going to get graded or help me get good grades hasn't seemed very justifiable, but hey, that couldn't last forever, right?

So, in the interest of spreading the love (well, love comes in all kinds of forms), I figured I'd comment just a little on a couple of noteworthy articles I came across today.

First - and most infuriating - of all, The Guardian reported today that the Department of Health reportedly watered down warnings on the NHS Choices information on homeopathy - which was initially supposed to mention that there is zero, nada, zilch, credible evidence to support the hypothesis that it does anything beyond offer a placebo effect. This was apparently the result of lobbying by the Foundation for Integrated Health. Sound familiar? It was the 'charity' founded by Prince Chuck to promote alternative medicine. Professor David Colquhoun submitted a Freedom of Information request to the DoH, under which correspondence revealing the above came to light.

I'm not even sure where to begin voicing my despair at the news! First of all - and this question has been uttered a million times before - what the hell is an unelected, born-into-privilege man with a PhD in talking to plants doing, once again trying to influence government policy? Liz, Your Maj, if you would be so kind as to abdicate pronto, to give son-dearest something else to occupy his mind and make him a little less bothersome, that'd be grand. Have a look across the mini-Pond and follow their example!

Anyway, secondly, I object to my tax money being spent on rubbish. I mean, obviously there are a lot of questionable ways in which the government spends my money and everyone else's, but this is not just questionable, it's demonstrably nonsense. When one registers for a National Insurance number, you should be offered a chance to 'opt out' of any spending on unproven treatments. I'd be quite happy to forego the right to access any of these cancer 'wonder drugs' and all complementary therapies, should I ever get cancer or any other serious illness. I'll take my chances with treatments that have been shown, in properly run trials, to be effective. Or alternatively I'd be happy to be chucked into a trial - which would be published with full access for all participants, of course... But I digress. Just like I don't approve of limited funds being spent on prohibitively expensive, largely unproven new drugs, I also disagree with the public funding of alternative medicine. It might be cheaper than those new drugs, but THEY'VE BEEN SHOWN TO BE INEFFECTIVE! I'd rather the NHS spends the money on some extra nurses, so hospitals would have the manpower to placebo-effect the hell out of their patients.

The other interesting story I came across appeared in the Daily Express. It reported on a new study, which supposedly suggests that a dietary supplement available in supermarkets could prevent diabetes and heart disease. The supplement, Bimuno, was given to a group of obese patients for a period of 12 weeks (with a four-week break somewhere? It's a bit hard to figure out the set-up from the article, which doesn't make a great deal of sense. You should check your writing, Jo Willey), while a control group was given a placebo.

The article explains early on that there are a number of 'risk factors' for health, which include low 'good' cholesterol, high blood pressure, high blood sugar and large waist. So far, so scare-mongering. Anyway, Miss Willey then reports: "The research shows that the prebiotic, called Bimuno can lower these symptoms, decreasing the risk of heart disease or diabetes." But then we get a bit further into the article, and she explains:

"Results showed that those who took Bimuno had significantly increased levels of “good” gut bacteria and lower levels of “bad” bacteria." That's not the same thing! I believe the study hasn't been published yet - at least, I can't find it online - so I suppose it's possible there were amazing results that the Express has simply chosen not to comment on, but considering the paper's love of hysteria, that seems a bit unlikely. And even if the supplement was indeed found to, say, lower blood pressure and blood sugar, a 12-week study is hardly going to give any indication whether these results will in fact reduce the incidence of heart disease and diabetes in the long run. But then, the Express being the reasonable paper it is, the article does actually mention that. It's there for all to see, in paragraph 15, where Dr Matthew Hobbs of Diabetes UK is allowed exactly one sentence on the subject.

Oh, I can't find much on the lead researcher, Jelena Vulevic, online. I don't see anything direct linking her to the makers of Bimuno, although she's given talks sponsored by the company. And this is not her first study involving the product - a study in 2008 tested it in elderly people. It found a positive effect. Shocking.

Happy Vday everyone!

Sunday, 23 December 2012

The Christmas spirit

After weeks of endless reinforcement of gender stereotypes in the form of 'his and hers' Christmas presents and a thousand other holiday-related nonsense articles that made me want to eat my eyeballs, on my final night at work before 2013, I finally came across a couple of articles that made me smile. So in the spirit of Christmas, or something, a not-so-angry post today!

The first one was an interview with Jim al-Khalili in the Independent, in which he talks about religion, Christmas and his appointment as the new head of the British Humanist Association. I'm a fan of his anyway, so in that respect I'm probably biased here, but it was great to read an interview with someone who is happy to say that while he is an atheist, he respects other people's rights to believe in god(s). While I absolutely adore Richard Dawkins, his constant Christian-baiting isn't productive, and - dare I say it - it gets a bit annoying at times. Although I can only assume his comments this week that raising a kid as a Catholic is worse than child abuse were made with the express intention of outraging 'Mad Mel' Phillips, which succeeded and of which I can only approve.

But I digress. Although Mr Al-Khalili defends the right of religious people to believe whatever they want, he is quite vocal about the need to keep those beliefs private - he advocates the exclusion of bishops from the House of Lords and argues against the teaching of creationism in science classes, as well as speaking out against the rise of pseudo-science in recent years. I for one look forward to having him as the president of the BHA because I think his 'niceness' can do much for humanism in the UK.

The second article that made me happy this morning was in the Guardian, which reported that Andrew Wakefield, the doctor struck off for causing the MMR vaccine scare, has won the inaugural Golden Duck award. Mr Wakefield beat Tory MP David Tredinnick and Prince Charles to the prize - I'm sure he'll be delighted with his win. Anyway, aside from making me laugh, it's also good to see that things are being done to raise awareness of pseudoscience and unsubstantiated claims. Hopefully, over time those who continue to believe in all kinds of alternative remedies will begin to appreciate the science that has shown time and again that these treatments are, in the best cases, no better than placebo, and in the worst they're outright dangerous.

Anyway, that's it from me for today. Merry Christmas everyone!

Tuesday, 18 December 2012

Hysteria, media and ministers

Today is certainly not a great day for health reporting - I lost count of the number of objectionable articles I came across at some point during the night, but I'll focus on a few I do remember. There was the government decision to rate surgeons based on death rates in future - admittedly not so much an issue of poor reporting as one of poor policy - as well as Nice's rejection of a cancer drug and yet another 'wonder drug' that's made it onto the front page of the Express.
Let's start with the surgeons' league tables proposed by the new NHS Commissioning Board - reported in pretty much every paper. I don't think there was anything wrong with the coverage, but I do disagree with the proposal: Sir David Nicholson wants to create publicly accessible league tables of NHS surgeons around the country, based on how many people die on their operating tables. On the surface, I suppose that's reasonable enough - who would want to be opened up by someone with a track record of seeing people die while they're under the knife, right? But on the other hand, I'm not sure I'm convinced this won't deter surgeons from taking on particularly risky operations because chances are it would make them look worse. If someone has had massive haemorrhaging in the brain due to a ruptured aneurysm, there's basically a 100pc chance they're going to die if they don't undergo surgery. However, the risk of death during or shortly after the surgery may still be 50/50 or worse - I can't help but wonder if risky operations such as those won't be turned down and declared inoperable in favour of more straightforward surgeries... Anyway, enough about that.
The Daily Telegraph today reports that the National Institute for Health and Clinical Excellence has decided to reject bevacizumab, marketed by Roche under the trade name Avastin, for the treatment of advanced ovarian cancer (sorry, I'd link to it but it seems to only be present in the hardcopy). There's a general tone of outrage at what is implied to be a grossly unfair decision by Nice, the agency everyone loves to hate. At no point does it go into any detail about the reasons Nice came to this decision, although it does mention that it is the first drug in 20 years to have slightly extended the average life expectancy of women with late stage ovarian cancer.
Compare the Telegraph's stance with this explanation, right near the top of an article on the same topic on the Bloomberg website ("Roche's Avastin fails to win Nice ovarian cancer backing"):
"Although Avastin used together with paclitaxel and carboplatin chemotherapy did seem to help delay the cancer’s spread, “it was unclear whether this translated into an overall survival benefit,” Andrew Dillon, NICE’s chief executive, said in the statement. “There was no evidence to show that the clinical benefit of the treatment justifies its cost, when compared to existing treatments.”"
Surprisingly, it seems Nice does in fact have logical reasons for rejecting the drug and doesn't simply deny use of this treatment out of spite against ovarian cancer sufferers!
Finally just a few quick words on today's Express front page, which claims a cure for high blood pressure has been found. I'm neither a doctor nor an academic or statistician so don't have the expertise to go into the treatment and trial in question in much detail, but there were a few things I wondered about - aside from a natural scepticism about any 'wonder treatments' that appear on the front page of the Daily Express, anyway.
First off, having had a look at the actual research report, this was a multi-centre trial, involving 24 centres in several countries. The combined number of participants, in the control group and the renal denervation group, was 106. Now, hypertension is VERY common. In fact, the report points out that in 2000, almost a billion people worldwide suffered from it. So could they really not find more than 4 eligible patients per centre? It sounds like a very low number in an unnecessarily high number of clinics - but then, as I pointed out, maybe that's just me being ignorant.
Secondly, the trial was funded by Medtronic, the company responsible for the Symplicity method used, and the lead author of the study was a medical adviser to, you guessed it, Medtronic, as well as being the Chief Medical Officer of its partner company Ardian. Obviously that doesn't mean he's not an excellent and honest researcher, but it does make me wonder if a little caution is needed in accepting the study's findings.
And lastly, as the report itself points out: the trial wasn't double-blind, and there was no 24-hour monitoring of blood pressure, so there is some room for error - which is being addressed by a follow-up trial. All in all, I think maybe the Express would've been wiser to wait until some results from that trial have come out before proclaiming that it "could be available on the NHS by early next year." Putting in some words of caution slightly earlier than the very last paragraph, where Professor Jeremy Pearson of the British Heart Foundation warns that "this new treatment will not be right for everyone, and we don’t know whether the benefit and safety will be long-lasting," would also have been nice.
Right, I actually came across more slightly shocking articles, but I think I've gone on enough for one day. If at this point you're still reading... well, thanks, I appreciate it. Oh, and if anyone can enlighten me on whether my criticism of the renal denervation study is way off the mark, that'd be fab. It's always good to learn on the way!