Sunday, 3 November 2013

WDDTY - the dangers of evidence

As some of you may know, my father is very seriously ill. In fact, he has probably only days left to live.  It was incredibly painful to see him yesterday, slouched in a chair, his dinner down his shirt, mumbling about my mother, who died five years ago, as if she were in the room.  Three days before, he had been alert and mentally quite alive - he even made a joke. 

He has battled with cancer for more than twenty years.  He has turned up dutifully at appointments with a variety of specialists all that time.  I sat with him seven years ago when he was undergoing chemotherapy for Non-Hodgkin's lymphoma as he sat rooted to the chair he was in for eight hours as the infusion seeped into his vein.  I went with him to radiotherapy appointments and more.  I took him to visit his relatives in the North. 

Now it would appear I need not have bothered because, for the price of some specially prepared distilled water, he could have been cured.  Incredible as it may seem, the act of diluting some fairly randomly chosen substance to the point of chemical invisibility and shaking it up in a particular way can kill tumour cells and give the patient back their life without the fear of the tumour breaking out of its prison and invading those tricky to reach parts, such as the brain or the liver.

That's what my father's cancers have done. Invaded both brain and liver, and elsewhere.  He has not been cured but he was given a good many extra and healthy years as a result of the radio and chemotherapies he was given all those years ago.  He barely complained. My mother did not once moan. He has not been courageous or brave but he has retained his dignity, until the last few weeks now that the rush of the oncoming end has robbed him of that.

Actually, I don't think for one moment that homeopathy can cure cancer.  There are lots of good reasons.  The first among many is that properly controlled trials do not support homeopathy.  Occasional results may suggest it has some efficacy, but probability suggests that sometimes the random noise of data will give a nudge in that direction.  When one finds the results heading predominantly in the same direction, it is unlikely that one study, one investigation, one treatment is going to reverse that trend.  In homeopathy it is like that.  Supporters will the results to go the other way but the trend is inevitably that homeopathy is not effective.

A second reason is the basic implausibility of the process.  Whereas in every other field of chemistry it would appear that an increase in concentration has an increasing effect, homeopathy pretends otherwise.  In the days before the atom was the consensus, it might have been possible to argue in the manner that homeopathists argue, but no longer.  To remove the active ingredient is surely to remove the action.  It cannot be anything else.  If I wanted to do someone harm, I would want more, rather than less, of my chosen poison in the wine I wanted them to drink.  It just doesn't make sense.

But, wait.  The homeopaths tell me that there is a possibility that water may somehow retain a memory of the active ingredient that has been dissolved within it.  To which I reply with two questions:

1) Why not cure the whole world by pouring some of the wonderful homeopathic remedy down the sink so it can enter the general water supply, thereby passing on its magical properties to all drinking water and thereby doing a huge amount of good for a minimal cost?  After all, isn't that the logical conclusion of this dilution business.

2) All that magically possessed water, what happens to its properties after ingestion?  Do they wear off?  How long do they last?  Why do we need to keep making the stuff when surely the case is that the answer to question 1 should be that all those nasty diseases that homeopathy can treat have been treated in everyone the world over and there is no need for any medicines any more?

The true answer is, of course, that no organisation or memory contained within the structure of the water molecules can last more than the tiniest fraction of a second.  Kinetic theory tells us that.  The laws of thermodynamics tell us that.  Anyone with a tiny bit of science education, in other words those that didn't fall asleep in their first year at secondary school, will see that homeopathy's basic premise is rubbish.  Take it by all means, but just don't expect miracles.

That's because it cannot work miracles.  It won't work miracles.  Wishful thinking is lovely.  But it doesn't cure cancer.  I would love it to do so.  I'd love to be able to get my dad to drink some special water and have him jump from his chair and dance all the way home.  But it won't happen.

Now to my point.  What Doctors Don't Tell You tells us that homeopathy can cure cancer.  Specifically, it tells us that breast cancer can be treated with homeopathy.  Fat lot of good that is to my dad.  However, evidence is evidence and relying on a piece of research to support the WDDTY version of events means that the evidence can be interrogated.  And so it proves. 

I am not an oncologist but I know someone who is.  Orac of the blog Respectful Insolence is, and it is to him that I defer when I want some oncological information.  Why?  Not because he is a paid shill of the pharmaceutical industry, whatever one of those is (and since in writing this I am one, can Big Pharma please make out the cheque in the usual way and send it to my home address) but because he has put in the days and nights of study that enable one to become an expert. 

About the only piece of evidence that WDDTY can bring to support their thesis is a paper, this paper: Frenkel M, Mishra BM, Sen S, Yang P, Pawlus A, Vence L, Leblanc A, Cohen L, Banerji P, Banerji P. (2010). Cytotoxic effects of ultra-diluted remedies on breast cancer cells. Int J Oncol. 2010 Feb;36(2):395-403.  Orac deals with it here.  If you are visiting these parts and are interested in homeopathy then you should read it.  Orac might not shake your beliefs but you might question them.  If this is the beam that the entire WDDTY homeopathy cures cancer edifice rests on, it is shaky indeed.

What happens when you critically analyse evidence is that it can give you answers and those are not always the answers the authors intended.  In this case, it appears impossible to tell if the homeopathic treatments actually had an effect.  The graphs are unusual, the evidence lacking statistical analysis.  It might be fair to say that perhaps the authors didn't know what they were doing, but peer review and editing should have spotted something.  And WDDTY don't use critical faculties that other, more properly sceptical folk, do use.  They read the paper properly.  They ask it questions.  Do the data warrant the conclusions?  How can we tell? 

So there is the danger of evidence.  It tells stories even if those stories are hidden.  After years of watching all those police procedural shows, from Columbo to CSI, we should be a little better at thinking about evidence, but some people aren't.  They take things at face value.  It is not a surprise that we have advertising to persuade us because some of us are easily persuaded.  I would hazard a guess that virtually all of us have a guilty secret, a purchase made on the basis of some slick advertising that we would rather not admit to.  Advertising works because we do not always stop to ask the question that needs to be asked.  Is it really true?

It has been said that WDDTY is actually more like a series of adverts dressed as articles interspersed in the advertising for holistic dentists (how can a dentist be holistic when they are treating your mouth which, by definition, is not your whole?) and vitamins (always vitamins).  If they are not trying to persuade their readers then there is little point in them existing because the articles are not evidence or fact based, not critical and definitely not what doctors in their right minds would tell you.

If we skip back a bit, Lynne McTaggart is sensitive to the claim that she claimed that vitamin C cures cancer and HIV.  One of the papers (sic) she relied on was one that suggested taking doses of vitamin C at levels just below those that cause at least one unpleasant side effect - diarrhoea.  It is often said that natural is safe, something that is palpably untrue with the most cursory of thoughts.  As the naturopath said to the judge in defence at her trial for murder, "I thought natural was safe. The extra digitalis should have caused no harm."

Sin is caused by omission as often as by commission.  What Doctors Don't Tell You has the capacity to cause harm by omission.  The omission of the reality of the evidence.  In the article on homeopathy and cancer in the November 2013 edition, it would have been fair to have pointed out that the Frenkel & al paper had been criticised, what those criticisms were and whether they were valid.  But of course that would have destroyed the story.  Well, that's what evidence does.  It takes your cherished beliefs and destroys them.  How many criminals have found that evidence trumps the thought that they might get away with it?  Lots.

One day, this week or next, the unpleasant evidence will come to me in the form of a phone call.  It won't be what I want. It will be the truth.  Truth is, in the end, not relative, not invented, not what someone would prefer it to be.  It is what the objective evidence says it is.  That is where What Doctors Don't Tell You fall down in my opinion.  There are plenty of science and health magazines that do the job properly.  This one doesn't.  And in so doing takes advantage of those patients and their families and friends who are desperate for a cure for whatever illness it is that is being suffered.

The Cancer Act 1939 is there to prevent cancer patients being taken for a ride.  What Doctors Don't Tell You don't like the Cancer Act.  It prevents them telling even more tall tales.  Thank goodness for that.

No comments:

Post a Comment