Oct 03
Posted by: nicholasswetenham  

***Edit 04/10/2009 – added more to this post***

I’m attending TAM (The Amaz!ng Meeting) London this weekend, and I thought I’d write a minipost about today – there’ll be more later.

Today’s speaker’s, in order of appearance, were:

Brian Cox – particle physicist, writer and TV personality. He discussed the Large Hadron Collider and the cutting edge of particle physics, and why he won’t be destroying the earth anytime soon.

Jon Ronson – befriends psychics, extremists and people with weird beliefs to better understand and investigate them. His book, The Men who Stare at Goats, is now a motion picture starring George Clooney and Ewan McGregor.

Simon Singh – popular science author. He discussed how he went from writing about codes and mathematics to pseudoscience, and about fighting the notorious libel case brought by the British Chiropractic Association.

Ariane Sherine – writer and Guardian columnist promoter of the ‘Atheist bus campaign’ which raised £150,000 and spread worldwide. There is now a book of essays by various well-known freethinkers, called The Atheist’s Guide to Christmas.

Ben Goldacre – Guardian columnist and writer of bestselling Bad Science. He discussed themes from his book and columns in condensed formed. He also made a more informal appearance at the comedy evening.

James Randi (via skype from US) – stage magician and pseudoscience debunker, founder of JREF, the foundation organising the event. He took a number of questions from the audience and received a standing ovation.

Other writers, like Mil Millington, and blogosphere personalities such as Crispian Jago and Jack of Kent (his post on today here) were present in the audience.

Simon Singh with his award (right) and his wife Anita (left)

Simon Singh with his award (right) and his wife Anita (left)

Most exciting event of today:

Simon Singh receive the TAM Award UK 2009  – presumably for his courage in battling his legal case. He received a standing ovation. Upon receiving the award, he announced the happy news that he and his wife are expecting a child. We here at blue genes wish him all the best. Apologies for iPhone photo quality!

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Sep 26
Posted by: benvincent  

At the end of April this year, a 90 minute film was released directed by a man called Brent Leung. This film was titled ‘House of Numbers’, and is shot in a documentary format with the claim of ‘objectively investigating whether HIV exists, and whether HIV causes AIDS’. The narrative soothingly reassures the audience that an objective and balanced approach is being taken, whilst the presentation in fact hugely attempts to lead viewers to a conclusion questioning scientific fact. The film gives credence to entirely invalidated arguments, and demands debate over subject matter long since resolved.

Mr. Leung claims on the ‘House of Numbers’ website in response to criticisms of the film by Huffington Post blogger Thomas DeLorenzo that:

“I am not a denialist. Posing questions is very different than denying something. Using that word and comparing it to holocaust denialists is nonsense — pure ad hominem which serves to only polarize a reasonable debate”

However as rightly pointed out by Jeanne Bergman at aidstruth.org, there is no ‘reasonable debate’ and as such Leung’s inquiries are operating with a presupposed agenda. This is supported by the fact that Dr. John Moore (one of the experts who was duped into appearing in the film) along with over a dozen other scientists who appeared have signed a letter rejecting denialist claims and stating they were misled about Leung’s intentions in making the film. (2)

It seems highly suspect to me that Leung, who advertises having had an interest in HIV and AIDS since his high-school days and has been ‘investigating’ the area full time, should make certain fairly basic errors. Firstly in a debate-turned furore which Leung attended, there appeared to be some confusion as to whether he knew AZT to be an antiretroviral – a rather basic fact given his so-called inquisitive role.

Secondly, in the trailer to his film Leung appears stunned at the idea of questions being asked about a patient’s sex life being used in the diagnostic process. As any medical student (or even avid fans of medical dramas such as ‘House’) could tell you, taking a history is an important and routine part of essentially every diagnostic investigation. Even this brief clip gives a distorted view of HIV testing, implying this quick finger-prick test is what doctors do as “a piece of theatre” with diagnosis resting only on the background questions asked. A nice little article giving some clarifying background on quick HIV tests such as the one Leung experienced can be found here.

These tests have the advantage of giving a result quickly, though are less reliable than ‘long’ tests and so are not used to provide a definitive HIV diagnosis. If a quick test is positive this would usually lead to a highly sensitive and specific ‘long’ test, and if this is positive, a Western Blot is performed for confirmation.

The fact that Leung officially takes a ‘neutral’ position demonstrates two major points. Firstly a position of supposed neutrality requires a person to not accept the scientific consensus. Because of the fact that this is exhaustive and as I said in my previous post at blue-genes is as certainly established as our heliocentric solar system, his stance is invalidated. Secondly his position allows him to skirt responsibility for any actions people may take as a result of conclusions they may erroneously draw from watching his film. It is also important to add that Leung has not divulged who funded his film. Whilst he has denied that most of them support AIDS denialism (perhaps they are merely ‘re-thinkers’?), it is highly suspect as this could potentially present a huge conflict of interest allowing even further criticism of Leung’s claims of objectivity.

An approach which denialists seem to like taking is to provide a distorted caricature of legitimate experts and reputable members of the scientific community. The device of presenting themselves as ‘innocent question-askers seeking truthful information’ is used to attempt to justify their claims of censorship ( see page 2 of the document linked) by the scientific community and also to win empathy with a lay-audience. The attempts by the academic community to prevent poisonously ignorant denialist messages from causing harm without validating their movement with ‘debate’ is re-hashed into what denialists try to pedal as a vast conspiracy theory. For more information I recommend Seth Kalichman’s wonderfully clear book ‘Denying AIDS’. Also, check out his blog.

When one approach doesn’t work, it seems standard fare for a denialist to simply bash on with another tack. When not acknowledged by the scientific community as ‘experts with a difference in opinion’, highly charged claims of attempts to repress the right free speech are bandied about. The scientific community is not concerned with repressing free speech as part of some farcical cover-up whilst some lord of big pharma laughs madly, stroking a white cat in his volcano lair. They are concerned with minimising the amount of illness and death caused by misinformation over what should be a non-issue.

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Sep 24
Posted by: colinhockings  

AIDS_Red_Ribbon.svg

When HIV was discovered as the causative agent of AIDS in 1984 (and has since been repeatedly proven, despite denialists claims – see Ben’s post) scientists were relieved: “It’s a virus! Phew, viruses are something we can deal with. Alright, somebody go cook up a vaccine: problem solved”. According to wikipedia, senior figures in the US health system claimed that a vaccine would be ready in as little as two years. 25 years later HIV is getting the better of us like no other disease, and the vaccine front has seen failure after failure. It seemed to me that it was truly impossible to build a vaccine against HIV and our only hope would be some form of procedure where T cells are removed from the patient, ‘cured’ of HIV (not quite as easy as it sounds, surprisingly enough) and reimplanted into irradiated patients – or something similarly novel (read: impossible and/or impractical). Imagine my surprise then when I finished work to find a BBC article saying that an HIV vaccine had ‘reduced infection’, and after a little bit of surfing I check Twitter to see that ‘HIV’ is trending. Even the Huffington Post had some (relatively) positive things to say.

So what’s all the fuss about? It’s hard to give much detail because the study – beautifully named RV144 – hasn’t yet been published (as far as I can tell, and I’ve looked pretty hard [Update: see footnotes]). There’s several press releases around, from all the various organisations that were involved, including:

  • MHRP (U.S. Military HIV Research Program)
  • UNAIDS (Joint United Nations Programme on HIV/AIDS)
  • NIAID (National Institute of Allergy and Infections Disease)

The study had two (blinded) groups, one control group (receiving placebo injections) and one experimental group (receiving four ‘prime’ doses of ALVAC HIV and two boost doses of AIDSVAX gp120 B/E), with over 8,000 volunteers in each group, lasting from 2003 until now. AIDSVAX has been tested before, but showed no effect, and the ALVAC has only been evaluated for safety. The researchers were quite careful to make the study as ethical as possible, giving lots of good safe sex advice and promising free medication to anyone who contracted HIV during the course of the study (as well as testing the participants for HIV every six months). The impact this has on the infection rate is clear to see in the results: 74 people in the control group and 51 vaccinated volunteers caught HIV – in a country where approximately 1 in 100 people is HIV positive. Before you say ‘well that’s a tiny difference’, remember that there were 16,402 people, which gives the study a fair amount of power. One would, however, need to take a look at the original data to be sure that the statistical significance is really significant. On a side note, I get really annoyed at studies that are released to the press before anyone is allowed to check the data. In this case it’s a large, well-known, highly-anticipated trial run by several reputable institutions so I’m sure their methodology isn’t intentionally dodgy, but it’s still very bad scientific practice.

I found an interesting 2004 release from TAG, the Treatment Action Group, which campaigns ‘for larger and more efficient research efforts…towards finding a cure for AIDS’, saying that the Thailand trial (called RV144) is flawed for several reasons.

  • A single experimental arm won’t allow the relative effects of the two vaccines to be tested. At the time, there had been no clinical trials of ALVAC vCP1521 efficacy and I don’t think that that has changed since then. If it’s still true then they have a very valid point: the experimenters cannot tell how much of the effect is from the ALVAC vaccine alone. TAG also had some concerns that the AIDSVAX gp120 boost may neutralise the other vaccine, based on experiments in macaque monkeys. It is therefore quite possible that ALVAC vCP1521 worked much better, but we won’t know until another large trial is completed.
  • TAG also questioned the ethics of recruiting volunteers – who mostly claimed altruism as their motivation for joining – to a trial that would, at best, lead only to further trials (based on the arguments above).

The reason why such a large trial was performed that won’t actually answer any questions is fairly stupid. It was planned well before two clinical trials for AIDSVAX came back negative, and a trial for the ALVAC vaccine (called HVTN 501) was cancelled. Despite the drastically changed circumstances, RV144 went ahead, leaving us with tantalising evidence that we’re making progress, but not really changing the game much.

On the bright side,  at least we have proof that HIV isn’t invincible. This study follows hot on the heels of the first case of a man cured of HIV (published in February 2009), so I think the entire AIDS research field is looking a little more optimistic. While the number of HIV positive people in the world is still increasing, I think it’s fair to say that we have good cause to be hopeful.

***Update***

Martin Robbins of the Lay Scientist is not so impressed. Apparently the results are only barely significant (p = 0.048 i.e. there is a 4.8% chance that the difference between the groups is down to random fluctuation)

ERV has an interesting description of thesoft of immunological reaction they were trying to elicit with the Prime-Boost strategy

***Update***

Katie Stover (Media Representative for NIAID) told me that the study will probably be published in October, in NEJM, to roughly coincide with the AIDS Vaccine conference in Paris

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Sep 22
Posted by: benvincent  

Hello readers, my name is Ben and I’m a new member of the Blue-Genes team. I’ve been friends with Nico and Colin during our time at university, but was  busy moving during the time the blog was founded. Now I’m here as a contributor, and will be posting again soon!

For scientists working in the field of HIV and AIDS, discussion of denialists can be at best tiring and at worst infuriating. This isn’t because a (‘good’) scientist can’t engage in a meaningful debate about their field with an honest dissident. It is because denialists of established science are not truly interested in objective examination of evidence. This may sound harsh, but it is important to realise that we’re not talking about any issues which have real controversy. The issue that I’m particularly talking about, the fact that HIV is the causative agent of AIDS, has over 25 years of medical science behind it, and is the subject of tens of thousands (1) of peer-reviewed research papers. The evidence is as irrefutable as that demonstrating that the earth orbits the sun, albeit perhaps less accessible to your average layperson.

Many may also dismiss denialist ramblings as the views of paranoid conspiracy theorists that have negligible influence on public perceptions. Unfortunately, undue attention has been given to the HIV and AIDS denialist movement due to the influence of particularly vocal leaders. The man generally regarded as the pole star of HIV denialism is the academic Peter Duesberg, who holds a Professorship with the department of Molecular and Cell biology at the University of California, Berkley. He is known for having performed work on the study of oncogenes, and was elected to the American National Academy of Science. Many people falsely see it as evidence for denialism that this impressive man holds views which would seem anathema compared to how one would expect a highly trained scientific mind to operate. One could indeed rhapsodise as to the reasons for this, but these reasons make not a jot of difference to the fact that his claims that the cause of AIDS is still controversial, and that the ‘Duesberg Hypothesis’ (claims that illegal drug abuse and antiretroviral medications themselves are the causes of AIDS) are demonstrably untrue (2).

HIV and AIDS denialism has had a painful influence on the governmental policies of South Africa. The previous Prime Minister Thabo Mbeki invited Duesberg and other denialists to sit on a 44-member ‘Presidential Advisory Panel’ to address the reliability of HIV test kits. The health minister at the time, Manto Tshabalala-Msimang rejected the use of antiretrovirals favouring an infamous approach based on eating beetroot, lemon, garlic and African sweet potatoes to save lives. It is concluded that hundreds of thousands of deaths (3) could have been avoided if a more rational approach to the issue could have been executed. The shady involvements of vitamin salespeople offering alternative respite has also tragically resulted in further confusion and death, with support from the government at the time.

An important concept to understand when considering a scientific issue is that of trust. Trust, slightly non-intuitively for some, is completely essential when engaging in scientific research or understanding issues said to be demonstrated by science. The scientific method (that is how scientists go about making new discoveries and ensuring they are well controlled, objectively conducted and concluded, and repeatable) is iterative in that it builds upon previously done work. Even to disagree with the interpretation of an experimental result or a potential theory necessitates allocation of trust, due to a previous benchmark of understanding of the field being required from which the dissidence can nucleate (4). The only way in which trust could hypothetically be avoided is to work from first principles – impossible in science unless you have an infinitely funded lab and the useful property of immortality and the patience to repeat well over a century of iterative experimentation.

It may be difficult to accept that trust in science isn’t particularly risky. Public suspicion rises with every less-than-satisfactory experience with one’s doctor or hospital, and most people in the know will confess that peer review is “flawed but the best we’ve got”. This highlights the importance of dissidence in relation to the system. It is important for people to question ideas which do not make sense to them, and to be able to have access to work done that has lead to the scientific community accepting the truth of particular issues. The earth is round. Vitamin C is required to prevent the onset of scurvy. HIV is the causative agent of AIDS. The difference between ‘dissidence’ and ‘denialism’ is that denialists maintain their stance (be it in regard to HIV and AIDS or any of many issues including the holocaust, or 9/11 as further highly emotionally charged examples) in the face of exhaustive and irrefutable evidence. It is not melodramatic to say that vocalisation of these particular falsehoods have been responsible for many deaths.

Sources and footnotes

  1. A search for ‘HIV’ in the PubMed database provides over 200,000 hits. Of course far from all of these will be connected to the HIV-AIDS link, my point is simply the amount of accredited research in this area is huge, only paling in comparison to cancer.
  2. Ascher, M., Sheppard, H., Jr, W., & Vittinghoff, E. (1993). Does drug use cause AIDS? Nature, 362 (6416), 103-104 DOI: 10.1038/362103a0 – Apologies that the full article is not available for free. However this gives one of many potential examples that peer reviewed examinations of Duesberg’s claims are out there, and if you note the date, were theoretically laid to rest a long time ago.
  3. Nattrass, N. (2008). AIDS and the Scientific Governance of Medicine in Post-Apartheid South Africa African Affairs, 107 (427), 157-176 DOI: 10.1093/afraf/adm087
  4. Recommended reading: Impure Science – AIDS, activism and the politics of knowledge, Stephen Epstein, 1996
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Sep 14
Posted by: nicholasswetenham  
Source: Wikimedia Commons Author: Oxyman

Source: Wikimedia Commons Author: Oxyman

It’s been a month since the clamour and bustle about healthcare reform during the US Congress’ summer break in August. The British blogosphere was then alight with spirited defenses of the NHS, like this piece from David Colquhoun. As Congress gets back to work, Obama is countering his critics with speeches on several of his main policy areas. Now that the dust has settled, I’d like to take a closer look at it.

Firstly, it’s worth noting that the NHS is incredibly popular as an instution. People love the NHS, although they often criticise government decisions made about it.

What is bemusing to us in the UK medical field is the way in which the NHS has been held to be an example of

1) An inefficient system

2) An unfair system that restricts access to treatments

3) Socialist or communist

4) The fate that could befall the US if healthcare reforms are passed

None of these are true. Before discussing the merits and drawbacks of the NHS, let’s take point 4 – the US has an insurance-based system and it will in all likelihood remain that way. As Atul Gawande points out in this excellent New Yorker article the healthcare system is like the phone system: you can’t just turn it off for a few months to replace it with something better. Health insurance systems developed naturally at first, with a varying course depending on local context, but now that they are in place they are very difficult and expensive to change by whatever means. It is therefore both highly improbable and probably undesirable for the US system to become like the NHS.

Many valid criticisms can be made of the NHS. As such, it is strange that its US critics have often strayed so far from reality in order to criticise it. The advantages of the NHS of 2009 are simple: free treatment for all with relatively short waiting times and good health outcomes, at a modest national cost of 8% of GDP per capita. Its disadvantages are: patchy funding depending on region for high-tech treatments that have a poor cost-effectiveness or are purely elective (the ‘postcode lottery’), wards with little privacy, and high rates of hospital-acquired infection.

It is pretty efficient, then, and fair to all – since we all get charged the same – nothing (although there is regional variation in service provision, as mentioned above). Although it may have been founded on socialist principles, no-one in the UK ever calls the NHS ’socialist’ or ’socialised’, it is simply not considered as such. And in any case, unlike in the States, most countries in Europe call their mainstream left-wing politicians Socialists, who are considering far milder than Communists (which many in the US seem to consider identical). The NHS co-exists with private insurers, who are still able to sell premium services despite competing with an excellent government-run system. This should have been one of concrete factual argument used by the Democrats for the feasibility of a public option, rather than the counter-argument it became in a fact-free environment.

Then of course, there were the inevitable hilarious ideas such as “Stephen Hawking wouldn’t have been allowed to live under the NHS” when he in fact says he owes his life to it.

By contrast, the US system costs an exorbitant 16% GDP per capita, does not cover a large fraction of the population, and has very little in the way of measures guaranteeing fairness. Half of that 16% is already spent on Medicare and Medicaid – so actually, Americans are spending proportionally just as many of their tax dollars on national healthcare programs as we are already, and see how much more we do with it. So to counter the fears of ‘rationing’, we actually provide more care to more people at the same cost.

It’s a shame that truly intelligent discussion of healthcare has been derailed by scaremongering and one-liners in the US. While we could accuse anti-reform adovcates of disingenuousness, it’s also clear that the Democrats failed to make a clear riposte to their arguments and a convincing case of their own. Intelligent and informed analysis pieces, such as this FT column, have been few and far between.

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Aug 26
Posted by: colinhockings  

If you’re a skeptic, particularly if you’re interested in the fight against pseudoscience and fuzzy logic in health care, Edzard Ernst is a man you should listen to closely. And if the name rings a faint bell you’ve probably heard of him as the co-author of ‘Trick or Treatment? Alternative Medicine on Trial‘ with Simon Singh. While there are hundreds of skeptical bloggers making a lot of noise about alternative medicine, Edzard Ernst’s full time job is to do it properly. With his group at the Peninsula Medical School (at the Universities of Exeter and Plymouth) he writes systematic reviews and meta-analyses of complementary medicine, as well as carrying out clinical trials (although apparently it’s been a while due to budget constraints) and writing books and articles for various newspapers. In short, he’s a very busy man, doing lots of important work – he’s published over 700 articles in peer-reviewed scientific journals!

In the last few weeks Edzard Ernst published two systematic reviews, one examining the utility of chiropractic spinal manipulation for asthma in children, and the other on chiropractic spinal manipulation for infantile colic. Those of you who are familiar with the ongoing trial of Simon Singh at the hands of the British Chiropractic Association will understand the significance. In short: Simon Singh is being sued because he pointed out that there was no evidence that chiropractic could help children with asthma or colic – among other pediatric complaints – and that the BCA promote it’s use for these conditions anyway.

I’ll give a quick summary of the two studies but I recommend reading them yourself (if you have access to the journals) because they are so short.

‘Spinal manipulation for asthma: A systematic review of randomised clinical trials’

They looked for every relevant study they could find on several databases as well as hand-searching references: a total of 35. Then they took out all the studies that weren’t randomised, didn’t study human patients (of any age), didn’t study chiropractic spinal manipulation (as opposed to other auxiliary treatments that are performed by chiropractors, or spinal manipulations performed by other professionals such as osteopaths), and didn’t study a clinical outcome. These criteria seem quite reasonable to me, but despite the bar being set so low only three studies were usable. Two of the studies concluded that there was no effect, and the third did not compare the control group with the experimental group ‘because of the high risk of committing type I and type II errors’. I don’t quite know if that is sufficient justification to avoid what most would consider the entire point of the experiment, but apparently they claimed to be a preliminary trial to determine the feasibility of a larger study. They did, however, deign to say that there was ‘little or no change’ between the patients before and after the manipulation.

Professor Ernst went on to say that the review wasn’t powerful enough (read: there aren’t enough strong studies) to prove chiropractic as being ineffective, but ’science in general and the RCT [Randomised Clinical Trial] in particular are not good tools for proving a negative’. Thus, and I think this is a very important point that applies to all claims by alternative medicine enthusiasts:

“[It is] the responsibility of those who claim spinal manipulation to be effective to demonstrate this beyond reasonable doubt. In the absence of such proof, any claim that spinal manipulation (or indeed any other therapy) is effective seems unjustified and irresponsible”

‘Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials’

This study was performed in much the same way as the other, however the trials that were considered to be of sufficient quality (3 out of 52) were still fairly poor, with low sample sizes and insufficient controls, as well as rubbish measures of outcome. Thus the conclusions that can be drawn are correspondingly shakier. The two slightly better trials reported no significant differences between the groups, and the methodology of the third trial, which reported a small change, was pretty dire to say the least. They didn’t report on the recruiting process, so it presumably consisted of asking parents to join a trial of chiropractic (and so probably selecting parents who believe that chiropractic will work), then they didn’t blind the parents as to whether or not their child had recieved chiropractic manipulation or a placebo drug, and then they relied solely on the parents evaluation of severity.

Colic is particularly interesting with regard to alternative medicine because we have very little idea about what causes it and no real idea about how to treat it. This sets the stage for lots of worried parents feeling powerless to help their children who are wracked with inconsolable crying, flushed faces, flatulence and ‘meteorism’ (drawing up their legs). The kicker is that it usually resolves spontaneously. It is easy to imagine parents who go their pediatrician being told not to worry, to just sit tight and wait, and when the disease has gone on for long enough they start hunting for alternative ‘remedies’ (here’s your regression to the mean). They may try a few different things and suddenly their child gets better. If I was an evil businessman representing chiropractic I would want to make sure that lots of parents come to see me for their baby’s colic because they’ll probably be converts for life once the child gets better on its own. To give you an idea of the magnitude of this effect, one retrospective study reported that 91% of colic patients showed a positive response to chiropractic.

One final note about these systematic reviews: anyone who would dismiss them as being written by Simon Singh’s friend to stack the evidence against the BCA has a tough case to argue. The point of a systematic review (as opposed to a run-of-the-mill, garden variety review) is to look at all the evidence on a certain topic, and evaluate it according to pre-defined criteria. In addition, the data-extraction and Jadad scoring (an assessment of the methodological quality) were performed by two independent reviewers.

Also highly recommended: Edzard Ernst published one of the best take-downs of the BCA ‘plethora of evidence’ in the BMJ a few months ago.

References:

This post was chosen as an Editor's Selection for ResearchBlogging.orgErnst E (2009). Spinal manipulation for asthma: A systematic review of randomised clinical trials. Respiratory medicine PMID: 19646855

Ernst E (2009). Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials. International journal of clinical practice, 63 (9), 1351-3 PMID: 19691620

—— Update ——

This post was chosen as an Editor’s Selection for ResearchBlogging.org

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Aug 11
Posted by: nicholasswetenham  

Should anyone be penalised for participating in a suicide, which of itself is not a crime? Should doctors be the guardians of life or should they be as Charon, providing passage between the worlds of life and death?

These to me seem to be the two distinct issues at the heart of the modern right-to-die debate and indeed the two that were debated at this year’s British Medical Association’s (BMA) Annual Representatives Meeting. On the first question, the BMA was ambivalent – it did not support a ‘change in the law’ to decriminalise prosecution of assisted suicide. On the second, there was a resounding ‘Guardians of life!’

The court success of Debbie Purdy in the House of Lords (Law Lords branch, which will be revamped as the Supreme Court in October) shows that the answer to these questions is still muddled in English law. The judge’s decision means that assisted suicide may effectively be legalised in the UK in the near future. A Number 10 Petition has been set up in riposte.

UK law is composed of  1. Case or common law (legal precedents set by court decisions which guide future cases) and 2. Statute Law (Acts of the UK Parliament or devolved nation Parliaments/Assemblies). At present suicide is legal under the UK Suicide Act 1961 but assisting it is not, although people who travel abroad to do it in jurisdictions where it is legal have not been prosecuted. The organisation Dignitas in Switzerland has now assisted somewhere in the hundreds of UK citizens in committing suicide, but no parties have been prosecuted. This is the result of court precedents but no statute upholds this as a freedom.

In usual alarmist style, the Daily Mail has published this article about assisted suicide in Oregon. They focus on one case of an unsuccesful assisted suicide. However, the stronger secular case for the current law, some of which are outlined in this FT letter (and then dismissed), are that it protects against the dangers of coercion into suicide by relatives or friends, a feeling that one is a burden and ‘ought to’ end one’s life, and a general trivialisation of suicide. Family situations are often complex and murky when viewed from the outside and it is easy to imagine that in any assisted suicide determining the extent to which living relatives encouraged or pushed their late relative into committing suicide is difficult in the best of circumstances.

In addition, suicidality often comes hand in hand with severe depression, and can be nothing more than a passing phase. It is likely that a large minority or even a majority of readers will experience depression at least once in their life, and if dealt with sensitively and appropriately it may be that any related death wish goes away in as little as a few months.

This is the reality on the ground for family doctors, the police, social workers, nurses, psychiatrists, palliative medicine doctors and other health workers. Any discussion of assisted suicide and euthanasia is inseparable from this reality; it is weak merely to argue ‘Yes, but if you are of sound mind you should be able to choose to end your own life’, which ignores the broader social context that all deaths happen in. However, ultimately autonomy and the freedom to choose one’s own care is a fundamental principle of liberty and of medical ethics and it is the ideal that we must strive towards.

Those countries where euthanasia or assisted suicide is legal usually have a number of safeguards present, such as requiring the approval of two doctors and/or a panel of experts, or as in Switzerland police inquiries after the fact. In the EU, euthanasia is legal in the whole of Benelux (fun fact – legalisation caused a minor constitutional crisis in Luxembourg when the Grand Duke refused to sign the law). However, in Netherlands, which has administered drugs for euthanasia in 1,000s of cases, the United Nations Human Rights Committee has highlighted concerns that regulation may be too lax.

In summary, in countries where assisted suicide is legal, a fairly large regulatory apparatus is necessary but perhaps not sufficient to prevent abuses. It also seems that there is some correlation between stringency of regulation and number of reported cases.

And what about doctors’ role in all this? Well, repeated votes at the BMA suggest that most doctors (or at least their professional representatives) don’t want to touch assisted suicide with a bargepole. Interestingly however, the Royal College of Nurses recently voted for a ‘neutral’ position. In practice if assisted suicide is decriminalised in the next few months in the UK,  nurses and doctors might be able to assist in some way pending review by regulatory bodies such as the General Medical Council.

So even if assisted suicide is decriminalised, it will continue to be a messy and controversial business. Find out more in my next ethics posts as the story unfolds.

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Aug 06
Posted by: nicholasswetenham  

Geeks among you might be familiar with TED, a series of conferences that started 0ut very tech-oriented but now deals with everything including complex global issues and cutting-edge science. Its motto is ‘Ideas worth spreading’. I used to be a big fan when I discovered that they made their talks public under a limited CC license. You can watch about 500 of them here. After a hardcore science talk by someone with no public speaking skills poring over reams of data in excruciating detail, these seem like a breath of fresh air.

But on closer inspection, I found that TED has two major issues:

1) Dumbing down. The flipside of the ’simple is beautiful’ 20-minute time limit and lay demographic, which makes the talks so accessible, is usually oversimplification of an issue or one-sidedness.

2) Dramatisation. They seem to love ‘revolutionary ideas’ (see how often that pops up in talks descriptions). Sadly, science and technology are not solely sudden breakthroughs by crazy geniuses. These geniuses require the more prosaically heroic work of tens of thousands of hours of plodding by unsung everyday scientists, and they are often wrong. As it turns out, crazy ideas are often just that.

TED, to its credit, doesn’t make any claims about the veracity of the claims but it does give people a shared platform with former US presidents, serving prime ministers, Bill Gates, and various Nobel laureates. That’s one big springboard.

So have they been over-promoting fringe scientific theories? Well they do feature repeated appearance of Craig Venter and Kary Mullis both of whom are mavericks with odd views when they stray from their own expertise (Mr. Venter wanted to use the reference human genome for commercial gain and Mr. Mullis is a global warming denialist and an AIDS denialist. Note the armchair.)

And then there’s this recently published talk. It’s Elaine Morgan, a distinguished writer and Oxford graduate who has been a strong voice in the feminist movement. She is defending the Aquatic Ape Hypothesis, which other than writing and the feminist cause is one of her great interests. It broadly refers to the idea that certain unique feature of humans among primates such as our thinner hair, and perhaps even bipedalism, can be explained by a history of aquatic or semi-aquatic life after the chimp-human split about 5 Million years ago. As she outlines its, it sound really neat. It also has a certain romance. But note that she doesn’t discuss the evidence, just complains that it has ‘never been properly looked at’. She also uses an argumentum ad Davido Attenburgo. It has been, and is generally considered seriously flawed for multiple reasons. There is Oreopithecus, a swamp-dwelling extinct (partially?) bipedal primate which would be nice as supporting evidence but we don’t really have anything that relates to the human lineage.

Those who know Colin well know that Evolutionary Biology frustrates him mightily, for while its foundation is strong the minor specifics that acadamics spend most of their time quibbling over are often debated in a hypothesis-rich and experiment-free context. This is because evolution is difficult to experiment on since it operates on geological timescales far greater than a scientist’s lifetime. This results in what he calls ‘armchair science’: sitting back in your gown with a pipe and saying “Well, I think this explanation is the more sensible-sounding one, don’t you old chap? Hurrah, we’ve cracked it. Open the port, would you Jeeves?”

Much to his satisfaction, I’m sure, both Kary Mullis denying global warming and Elaine Morgan discussing a fringe theory of human evolution is done from a seated position.

In short, TED has given a lot of publicity to a hypothesis which probably did not merit it. For some serious discussion of the actual science, people far cleverer than me have discussed it on the blogosphere recently, presumably in response to questions arising from TED publicity. Highly recommended reading:

Greg Laden of Scienceblogs

Jim Moore’s comprehensive critique

***Edit 07/08/2009***

Oh, and so that I don’t bash TED too much, here is one excellent TED talks by Hans Rosling - the one that originally got me hooked:

Hans Rosling on the developing world

With the infinitely powerful lens of hindsight I now see that this is because he shows data. Lots and lot of it. In fact he has to talkveryfast and use an animated data visualisation tool to be able to present all of it in 20 minutes. Without these added bonuses, the amount of data in most TED talks is minimal.

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Jul 30
Posted by: colinhockings  

Ladies and Gentlemen! Head on over to Beyond The Short Coat for the Skeptics’ Circle: your fortnightly romp through skeptical posts, be they about the Obama birth certificate conspiracy, the latest pseudoscientific concoction, or whatever else people need a dose of evidence-based evaluation about today. You may also find a link to my first ever post! A cup of skepticism about the promises of green tea for prostate cancer.

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Jul 22
Posted by: colinhockings  

Leukemia. I’ve dropped a hint or two that I may be talking a little about leukemia on this blog, and I’ve found the perfect way to start. Today, my attention was directed to a video about a girl called Melisa Paskova, a nine year-old girl from Macedonia, who’s been diagnosed with a resurgence of the leukemia she thought she’d defeated a few years ago. If you speak German, I recommend you watch: it’s a heart-wrenching story.

Melisa came to Essen, Germany for a bone marrow transplant which represents her best hope of beating the cancer once and for all. Bone marrow transplants are life-saving for a variety of diseases, but it is sadly very rare to find an acceptable donor. Luckily for Melisa, her older sister (10) is a perfect match, so she has a very good prognosis. Unfortunately, the insurance company refused to foot the c. €100,000 bill, and she was on television essentially to ask for money. While everyone I watched this with immediately started trying to make a donation, it emerged that in the few days since she was on TV (RTL on the 15th, and WDR on the 18th) they’ve managed to raise more than enough money: €142,000 according to the fund-raising website!

Cancer is most commonly a disease of older people, which is what makes leukemia so terrifying. It strikes children and tears families apart. The speed with which so many people gave their support to this girl shows that it’s not just the leukemia researchers I’m working with that are touched by this, but I believe everyone can, in some way, picture their children losing their hair and dying slowly while they are powerless to help.

There’s been a great deal of research into leukemia, and the sort of operation that Melisa will undergo is a very recent development. Looking to the future, we are seeing breakthroughs in understanding the causes of leukemia that are going to make their way into the clinic, hopefully within the next 10-15 years. The reason that the people in my lab had been pointed to the video in the first place was that one of the scientists featured had previously worked here, a fact that really brought the story home to me. It’s very heartening to be reminded that what we do here will save lives, even the lives of children that haven’t been born yet.

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