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While musing on the nature of evidence, and what is or is not considered ‘evidence’ in all the various contexts evidence is used, I came across this excellent rapid response in the BMJ back in 2004 by Clifford Miller, “a practising English lawyer, graduate in physics and a sometime examining lecturer on law, standards and ethics (particularly, the law of evidence) to Masters student technologists at the Imperial College of Science Technology and Medicine”.

He writes, in the context of the imputed association between MMR vaccination and the onset of autistic states, on “The Unreliability of Scientific Papers as Evidence”:

“Reliable evidence is that which is authentic, accurate and complete. In short, scientific evidence is incomplete if used for purposes outside the strict confines of science because it fails to take account of evidence of lay witnesses of the facts and is hence only applicable to the narrow and specific confines of scientific enquiry and not the broader ones found in other fields of human endeavour.

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This is the second paragraph from Ben Goldacre’s recent comment piece Benefits and risks of homeopathy in The Lancet’s November 17 edition.

During the cholera epidemic in the 19th century, death rates at the London Homoeopathic Hospital were three times lower than those at the Middlesex Hospital. (6) The reason for homoeopathy’s success in this epidemic is even more interesting than the placebo effect. At the time, nobody could treat cholera, and while medical treatments such as blood-letting were actively harmful, the homoeopaths’ treatments were at least inert.

(6) Hempel S. The medical detective. London, UK: Granta Books, 2006

Notice how Goldacre doesn’t give us the actual figures. (And this is The Lancet, not the Guardian.) Neither does he clarify that his reasoning is speculation, not established fact. The actual mortality percentages would allow readers to make some kind of sensible judgement about his conjecture that medical treatments exacerbated mortality while homeopathic treatment equated to no treatment at all.

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This is the first paragraph from Ben Goldacre’s recent comment piece Benefits and risks of homeopathy in The Lancet‘s November 17 edition.

Five large meta-analyses of homoeopathy trials have been done. All have had the same result: after excluding methodologically inadequate trials and accounting for publication bias, homoeopathy produced no statistically significant benefit over placebo. 1–5

(1) Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homoeopathy. BMJ 1991; 302: 316–23.
(2) Boissel JP, Cucherat M, Haugh M, Gauthier E. Critical literature review on the effectiveness of homoeopathy: overview of data from homoeopathic medicine trials. Brussels, Belgium: Homoeopathic Medicine Research Group. Report to the European Commission. 1996: 195–210.
(3) Linde K, Melchart D. Randomized controlled trials of individualized homeopathy: a state-of-the-art review. J Alter Complement Med 1998; 4: 371–88.
(4) Cucherat M, Haugh MC, Gooch M, Boissel JP. Evidence of clinical efficacy of homeopathy: a meta-analysis of clinical trials. Eur J Clin Pharmacol 2000; 56: 27–33
(5) Shang A, Huwiler-Müntener K, Nartey L, et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 2005; 366: 726–32

Note that Goldacre omits the Linde et al meta-analysis published in The Lancet in 1997 (6) from his listed studies.

Below are comments and conclusions from each of these studies. Remember, Goldacre is saying that they each support his assertion that homeopathy has no statistically significant benefit over placebo.

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OK. Enough is enough. Everyone’s entitled to their own opinions, but when they start claiming their opinions are ‘scientific’, write comments in learned journals quoting published papers in support of their arguments which don’t actually support their arguments at all, misrepresent statistics and generally twist things so far around their little fingers it defies belief, then if you’re a scientist, a homeopath, both or neither, it’s time to put the record straight.

Dr Ben Goldacre, junior doctor and journalist for the UK Guardian, has been adopting a high profile of late. His attacks on alternative therapies, and homeopathy in particular, have reached such a fever pitch it resembles more of a witch-hunt than a scientific debate. Of course all spindoctors know that if you repeat something often enough, sooner or later people start to believe it, whether it’s true or not. Goldacre’s writings, featuring a persuasive mix of jocular sarcasm, apparent scientific plausibility and fearmongering, would have you believe there’s now scientific consensus from unanimous evidence proving that homeopathy is no more than placebo. It’s one thing to publish that in the popular press, another entirely when it appears in The Lancet.

There is, in fact, no factual basis for these assertions. The evidence Goldacre cites doesn’t back up his claims and the ‘science’ he claims to champion is little more than opinion and spin. Of course I don’t expect you to believe me just because I said so, or even because I include citations (1) of papers published in peer reviewed journals in my footnotes. I’m not even asking you to believe me. I’m asking you to look at the actual scientific proof itself, and to do so with a thorough and critical eye.

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