Right folks, no sitting on the sidelines. Your healthcare is far too important. When I shout in social media about the damage being done to the NHS by this current UK government, I sometimes get the impression that some of you out there either think this is all a fuss over nothing, or is about self-interest on the part of the medical profession. Jezza is RELYING on you thinking that - he's spent considerable time on media manipulation and spin, and is currently being opportunist in times of austerity, to help consolidate that impression.
Don't let government grind down those trying to secure the welfare of you and your nearest and dearest. The NHS is a superb healthcare provider (as judged by independent assessors) but this Tory government would much rather use ill health to line the pockets of private healthcare companies at the expense of those who can't afford private healthcare, and with cavalier disregard for uniform quality of care. Public sector healthcare professionals are those who stand in their way and therefore must be vilified (to undermine public confidence in them) and demoralised so that they move abroad or out of the public sector. It's hard to think of one group of healthcare individuals or NHS providers which has escaped a campaign of negative propaganda.
As is my usual habit, I'll illustrate my point with a tune. Forgive my mixing of metaphors but this one's doing the rounds, and deserves to become viral:
So... since posting earlier today, the youtube account which uploaded the above video has been terminated.... which has forced me to send you to a site I don't usually insert links to, but needs must so:
A quote from a Bruce Cockburn song I referenced in one of my earliest posts. After an evening of mocking ghosts, ghouls, opened graves, beasts from hell, and creepy things (plus associated, in pagan Samhain, with the swallowing up of light by the darkness of winter) comes All Saints Day. Lest Halloween overshadow the day which follows it, here are a few music vids suitable for the occasion. Last year's post referenced a few saints (and unfortunately Youtube has pulled one of the videos since); this year I thought I'd dig into the subject a bit more - using music, natch. Since I'm not long back from a trip to N'awlins, you might notice a wee Big Easy influence here or there...
But we often gotta start with the dark to notice the light, so here's a saintly song which starts right there, with the grim reaper hovering:
"Get six gamblers to carry my coffin Six chorus girls to sing me a song
Put a twenty-piece jazz band on my tail gate
To raise Hell as we go along."
OK so maybe the time for hell-raising's gone, but the jazz idea... let's run with it. There are so many great versions of this song to choose from that I just had to include 2 other variations. Here's sultry chanteuse Cassandra Wilson:
and a more upbeat version from the Preservation Hall crew:
So... this idea of saints, and All Saints Day, stems from the Christian notion of the bond between those who have died in the faith and those who are currently trying to walk the walk here - what the 4th Century Apostles Creed* refers to as the "communion of saints." Different denominations may take slightly different angles on this notion but the idea of unity between those alive and those gone before is a central theme.
Isn't it pretty arrogant for a community to self-describe its members as saints? Well yes.... if it's a claim of personal achievement and the title is only supposed to be reserved for those with particularly noble characters. But there's the problem - it lies with a dodgy definition. Most of the Biblical characters deemed saints had their faults well recorded in the text, the same text which refers to those who believe as saints. So it's a statement of hope and expectation of those who see that a change is required, not a claim of achievement by the individuals of personal purity.
Don't believe me? Take it from guys who resist the title, and have professed sympathy for the devil:
"Saint Paul the persecutor
Was a cruel and sinful man
Jesus hit him with a blinding light
And then his life began
I said yeah
I said yeah
Augustin knew temptation
He loved women, wine and song
And all the special pleasures
Of doing something wrong
I said yeah
I said yeah
I said yeah, oh yeah, oh yeah
You'll never make a saint of me
Oh yeah, oh yeah
You'll never make a saint of me"
In St John's Book of Revelation (a pastoral book for people suffering under persecution rather than a book to be mined for explicit detail of a sequence of events in the future), the suffering saints cry out "How Long?"
So do Bono and Billie Joe Armstrong:
The wait may seem long, but the saints look forward with hope and trust of future fix. So someone should really write a tune to celebrate that. Oh wait...
That's quite a communion up there on stage. A lot of my faves as well as BBK - Slash, Derek Trucks, Susan Tedeschi... heck there's even room in the communion for a ginger (Mick Hucknall)....
But, tho' I'm not among the most faithful of followers at the temple of Bruce, for me this is the most worshipful version....
Happy All Saints Day!
*present form of words dates from as late as 8th Century but main components go back at least to 4th, if not to 1st Century.
"Science is temporary, changeable, constantly revising itself, like a transient fad."
Is that your impression?
This summer I finally got around to reading Ben Goldacre's Bad Science. It's been out since 2008 but, since I figured I'd already come across plenty of bad science from the late 1980's onward (and before, but I likely didn't recognise it prior to that), it didn't seem a priority read for me. It should have been, not least because then I would have been strongly recommending it for the last 6 years to all my friends whose field of study was in the arts rather than in science. You know who you are... get it and read it!
It's accessible, funny and useful, and focuses particularly on health sciences. It tackles head on many misconceptions about science, and particularly its often woeful handling in the media (which reinforces general misconceptions) - alongside ruthless exposure of things masquerading as science such as homeopathy and 'nutritionism.' It equips anyone to understand the basics of the scientific approach to gaining reliable knowledge, and demolishes the notion that it can only be understood by a select few boffins with big foreheads, white coats and big egos. Particularly, it squashes the media-fostered impression that scientific findings are merely pronouncements of the opinions of experts (with one expert opinion as valid as another, instead of identifying the charlatans). Goldacre points out that, while science can be 'temporary' or 'changing' as it pushes at the limits of knowledge, "Archimedes has been right about why things float for a couple of millennia... and Newtonian physics will probably be right about the behaviour of snooker balls forever." Yet, perhaps because of how the cutting edges get reported, the notion of changeability permeates (in the imagination of many) back to the core findings. The book has a particular focus on medical science and should increase your ability to separate dangerous fiction/fantasy on health issues from fact. If you haven't read the book, do so - seriously.
Contrary to the opinion of some (especially those readily embracing post-modernism), science can't be arrogant - any more than your lawnmower is - it's a tool. The irony is that the scientific method functions by actively seeking to prove its findings wrong. Sure, scientists can be arrogant (you might call some tools too but that's in a different sense entirely), and so can professional gardeners, and sportsmen, but most of us can tell whether someone's done a botched job with the lawn, or the penalty kick... if we actually look... Most of us can also recognise it's not a good idea to bring the mower indoors to hoover the carpet. So it is with science. Goldacre provides plenty of examples - some humorous, some tragic - but crucially he does not leave the reader with just a list of anecdotes; rather he gives those not versed in science a few simple tools to allow them to assess claims and recognise quackery for themselves.
Time for a musical interlude (click the arrow)
Trust yourself_New Pony
I trust myself reading scientific claims, and I trusted myself reading Ben Goldacre's book too. I don't accept everything he says (of which more later) but he says so much so well that you really should read it too, if you're as slow off the mark as I've been.
A land of wolves and thieves.
One of his first targets is 'Dr' Gillian McKeith (more recently infamous from her appalling appearances on TV show I'm A Celebrity, Get Me Out Of Here), who styled herself as a scientific authority on nutrition, posing amongst scientific props, and making pronouncements which schoolkids should recognise from biology lessons as being ridiculous. Just one example is her claim that we should eat spinach and darker leaved plants because "they really oxygenate your blood" as they contain more chlorophyll. Goldacre is pretty direct in pointing out the nonsense:
"Is chlorophyll high in oxygen? No. It helps to make oxygen. In sunlight. And it's pretty dark in your bowels. [Ed - maybe Dr McKeith has never heard the phrase 'stick it where the sun don't shine.'] In fact if there's any light in there at all then something's gone badly wrong. So any chlorophyll you eat will not create oxygen, and even if it did, even if Dr Gillian McKeith PhD stuck a searchlight right up your bum to prove her point, and your salad began photosynthesising, even if she insufflated your guts with carbon dioxide through a tube to give the chloroplasts something to work with [ie as fuel for photosynthesis of which oxygen is a byproduct] and by some miracle you really did start to produce oxygen in there, you still wouldn't absorb a significant amount of it through your bowel, because your bowel is adapted to absorb food, while your lungs are optimised to absorb oxygen. You do not have gills in your bowels..."
He then goes on to disclose the nature of her PhD. It's from a non-accredited correspondence course college, which sells its own range of vitamin pills through its website, although her management website had incorrectly stated it was from the American College of Nutrition - she claims this was a mistake which was someone else's fault although one of her books carried the same 'mistake'. Goldacre also highlights that she has fallen foul of the Advertising Standards Authority, and has been obliged to cease referring to herself as 'doctor' in her promotional material.
He also targets the widespread marketing of all sorts of medications on the basis of misleading data, including fish oils to improve children's academic performance, and herbal medicines to treat whole range of false 'diseases', sometimes whilst denying access to proper evidence-based medicines for diseases which are very real, including HIV/AIDS - as occurred scandalously in South Africa- or the case of MMR vaccine in the UK. He points out that Christian groups seeking to help have sometimes got in the way of effective programmes to reduce the spread of disease. But he does this whilst being sensitive toward the "Christian value system."
The sins of the Pharmaceutical Industry, in hiding or misrepresenting scientific data for commercial benefit, are also tackled, but he's merciless in pointing out the even graver abominations of the Homeopathists. The claims of the latter, advocating dilutions of poison for health benefit, are examined closely - as is the nonsense of water having a (selective) memory.
Goldacre points out potential problems with patient advocacy groups, or pressure groups, seeking funding of drugs of questionable benefit, and the harm this can do to society as a whole in the context of a finite healthcare budget. It can undermine appropriate priority-setting (as of course can politicians rushing to put out fires lit on various TV and radio shows, creating other catastrophes or inequalities in the process).
In my view, some of the most valuable content in the book is the exposure of just how badly the media handle scientific subjects, and how this reinforces widespread societal notions that science is impenetrable to all but a few boffins. As he puts it:
"Science is portrayed as groundless, incomprehensible didactic truth statements from scientists, who themselves are socially powerful, arbitrary, unelected authority figures. They are detached from reality; they do work that is either wacky or dangerous, but either way, everything in science is tenuous, contradictory, probably going to change soon and, most ridiculously, 'hard to understand'. Having created this parody, the commentariat then attack it, as if they were genuinely critiquing what science is all about. [Ed - sounds like Richard Dawkins' approach to Christian faith]
Science stories generally fall into one of three categories: the wacky stories, the 'breakthrough' stories, and the 'scare' stories. Each undermines and distorts science in its own idiosyncratic way."
If the above is your impression of science, you need to read this book. (Did I say that before?)
It seems that viewing figures/circulation are the altar on which proper coverage is sacrificed. Sometimes promotional activity is thinly disguised as news; sometimes the most unscientific matters are presented as if scientific (eg a finding that Jessica Alba has the perfect 'wiggle'). Personally I find it really frustrating how frequently the media report "breakthroughs" which are nothing of the sort, or at the very least have still to complete the peer review process which is crucial to determining whether something is actually significant progress.
This week they were at it again, misrepresenting scientific work on black holes, and again creating the impression that this was all just a matter of 'boffins' arguing/speculating and no way of the rest of us knowing (or caring) what the facts actually are. Science got it wrong again, and all that. Who knows what to believe of what these guys/gals tell us. You crazy science guys...
The article confuses speculative hypothesis-building (albeit using maths) and feasibility testing with areas of widely established scientific fact (like the existence of black holes, and the 'Big Bang').
Equally frustrating is the superficial attempt to achieve "balance" in reports, where the balance is just a matter of finding two experts with differing opinions, even if one is a complete maverick, or totally lacking in credibility in the discipline. Goldacre goes as far as leaving blame at the door of the media for the harm to children as a result of what he terms "The Media's MMR Hoax." Stories around mercury in your fillings also grab his attention.
In a chapter entitled "Why Clever People Believe Stupid Things" Goldacre shows well the reasons why we should beware of making assessments based just on intuition, when more robust and reliable methods are available to determine what is or is not the case. Let's use them when they're suitable to the task in hand.
OK - there are a few instances where he doesn't live up to the standard he sets for others - like lumping creationism in with Creation, and potentially forcing a false dichotomy between a belief in Creation, and scientific revelation. In Chapter 5, he throws in a rather lazy "just as the Big Bang Theory is far more interesting than the creation story in Genesis..." This is so vague as to be worthy of the same kind of (appropriate) criticism he dishes out to journalists and cosmetics or homeopathy peddlers. 'Far more interesting' in what sense? As (part) mechanism of the early universe and its subsequent development, sure. As study of the mythology of ancient cultures? No. As having something pastoral to offer people under oppression (as were the first hearers of Genesis)? No. As impacting on the existence or otherwise of God or gods? No. As providing an understanding of the development of JudeoChristian thought (whether you espouse that theology or not)? No. In fairness, he doesn't indulge in a parody of religious belief which is then up for critique, but he might be better either avoiding the subject or handling it better than your average Daily Mail journalist handles science.
Interestingly, Goldacre gives a favourable description of an external reference for ethics - the Declaration of Helsinki. He refers to it as "the international ethics bible." Of course, ethics is a tricky matter to subject to 'empirical testing' in the usual scientific sense. So scientists tend to go with what a bunch of us thinks best. Let's call it conscience. Not scientific at all, but highly necessary.
Perhaps difficulties accessing science is not all the fault of the media. Maybe scientists could be a bit more imaginative and creative in writing and communicating. Maybe they/we could reference the world of literature or the arts, if the journal editors/peer reviewers will allow them/us. The first two references (of over 300) in my own MD research thesis from 1995 are to ancient literary texts*, but arguably you have more latitude with a thesis for a higher degree than with scientific journals. However, it's recently come to light that a bunch of Swedes have taken the concept of literary reference to a whole new level...
Of course, looking at the affiliation of the senior author (Weitzberg), it's no surprise to me to find such a great contribution coming from an intensivist ;-). We intensivists are frequently engaged in blowing in the wind with mechanical ventilators. Usually it's oxygen-enriched air that's delivered, but occasionally we supplement high levels of oxygen with inhaled Nitric Oxide, as I did recently to a patient with critical oxygenation. (I didn't think of adding spinach to the patient's tube feeding regimen).
It is a significant feat, tho, to get Dylan into Nature... after all, Dylan himself did write in one of his songs "Nature neither honors nor forgives"...
A report from Gawker suggests that the concept is getting competitive:
There's also Professor Kenneth Chien's 1998 publication in Circulation, entitled "Tangled Up in Blue: Molecular Cardiology in the Postmolecular Era." And in 2010 Weitzberg followed up his earlier publication with The Biological Role of Nitrate and Nitrite: the times they are a-changin' in the Journal Nitric Oxide, and in 2011 Dietary Nitrate - A Slow Train Coming.
As journals are increasingly electronic, who'll be the first to get an audio track piggybacked on their paper?
I think Ben Goldacre would approve of a couple of Dylan quotes of my own.
"You got unrighteous doctors dealing drugs that'll never cure your ills
When you gonna wake up?..."
It's not individual scientists that we should be trusting, it's the scientific method which ultimately keeps them honest, or exposes them as wrong. And the method is transparent to all, not just the scientific community. The second quote is from Dylan's song on the Golden Rule:
"Don't put my faith in nobody, not even a scientist."
I guess we could add a line to the Word of Bob...
"no red-top journalist, and no way a homeopathist."
Tom Waits has a fitting tune which we could dedicate to those who continue to exploit others with homeopathy in the face of evidence that it doesn't work.
"A rat always knows when he's in with weasels...
They all have ways to make you pay."
*Leviticus 17 v 11 & Deuteronomy 12 v 23.