Thursday, 27 September 2007

Ear candling - the BBC's dustier corners

I mentioned in the previous post that the BBC's Complementary Medicine health section had been revised. I still think it's inferior to Channel 4's (which for every therapy has a prominent "what's the evidence?" paragraph that isn't afraid to say when there's none). But at least the BBC section shows evidence of editorial standards and some attempt at neutrality within the text; even though there's a disclaimer at the foot, they don't just use it as token balance to unchecked expositions of every weird therapy.
      I'm sorry to say that once you get away from the main sections on the BBC website, it all changes. I was just looking at BBC South East Wales Mind, Body and Spirit, and the standards there are at about the level of local free advertorial leaflets. A particular offender is the Hopi Ear Candling page, in which "Laura Warren, a complementary health practitioner in Cardiff, offers some tips about one of her specialities". This appears to offer a) free advertising for her service; b) free advertising for the merits of a product she uses, Biosun candles ("one of the only EU standard candles on the market"), and c) a factually untrue exposition on the action of ear candles ("The candle creates a mild suction which lets the vapours gently massage the eardrum and auditory canal. Once the candle is placed in the ear it forms a seal which enables wax and other impurities to be drawn out of the ear").
      It's not difficult to find debunkings of ear candling. Check out Why Ear Candling Is Not a Good Idea, How do "ear candles" work?, Waxing sceptical, On Ear Cones and Candles, Listen up: Beware of the 'ear candle', and finally, from the journal Laryngoscope, a paper on ear candling injuries, Ear candles--efficacy and safety. As I said in the previous post, I doubt any complaint about factual accuracy will wash, but maybe the risk of injury will. The BBC Wales page has an extensive disclaimer at its foot, but I think that's a cop-out that doesn't absolve the BBC of hosting material that's blatant advertising and potentially dangerous. For the record (sent to BBC Complaints today):

Editorial standards / safety of material hosted
Hopi Ear Candling. Despite the disclaimer on what is obviously a personal view, I don't think it's acceptable for the BBC website to host such a one-sided view of the topic. It is:
a) A blatant advert for both Laura Warren and Biosun candles, a product she uses.
b) Factually inaccurate: the claim that ear candling sucks impurities from the ear has been widely debunked.
c) Potentially dangerous: see "Ear candles--efficacy and safety" in the journal Laryngoscope ("A survey of 122 otolaryngologists identified 21 ear injuries resulting from ear candle use. Ear candles have no benefit in the management of cerumen and may result in serious injury").
I hope you will reconsider the hosting of this material.
Sincerely, Ray Girvan

Media and bad science #1 - correction

As a major news medium, the BBC has a vast influence on the dissemination and perceived validation of information. Like most media outlets, it makes mistakes. How good is it at correcting them?
      I've had mixed experiences. Generally the front-line 'techie' editors are excellent; I've had prompt corrections over things like the name of a mineral or an inaccurate explanation of the Space Shuttle reentry manoeuvre. I had a very prompt reply and cordial discussion with Nick Higham over my comments on his When science and journalism collide, which I recommend as an even-handed analysis of many of the issues that drive the divide between what scientists do and how the press reports it.
      However, my predominant impression is that over matters of science, the BBC has a deep resistance to correction. My particular idée fixe is its reportage of an alleged Three headed frog, a stupid story that persists on the BBC website after three years, despite my repeated attempts to draw their attention to my debunking of it as a simple case of multiple amplexus (i.e. frog mating grip). If any herpetologists are reading this and you agree with me, the complaints page is thisaway.

Another example was the saga of its coverage of the alternative medical technique of craniosacral therapy. In its original form in 2004 the text, by Jacqueline Young, stated "US osteopath William Garner Sutherland ... found that the cranial bones (the skull bones encasing the brain) weren't fused in adulthood, as was widely believed, but had a cycle of slight involuntary movement". This is nonsense: there is no evidence that cranial bones move, and practitioners don't even agree on what they feel when given the same patient (see Quackwatch and Bad Science). All I asked of them was that they report this is a belief rather than a fact.
      I complained in October 2004. After several months I was told the article's writer "was aware of the situation" and that the issue is being "debated by osteopaths in their professional journal. She is currently investigating and depending on her findings the article will be re-worded". After a year the article was changed to say "Sutherland believed that the cranial bones ... weren't fused in adulthood" but it was still biased by omission of counterevidence, unlike the Channel 4 counterpart.
      Finally, after a site overhaul in February 2007, they did something. Craniosacral therapy is now included under the Osteopathy section, which says "Practitioners claim to be able to feel the ebb and flow of this fluid, but sceptics reject this and say there's no good evidence for movement of the cranial bones after infancy". Credit where it's due: that's all I asked. But it shouldn't take three years to get it done.

At the time, as a wider issue, I commented on the BBC website's whole coverage of complementary medicine (again, in contrast to Channel 4). You can read the full details here, but the gist is that I argued that the whole section - for failing to offer the context of mainstream opinion - was in breach of its then Producer's Guidelines on impartiality, which stated "Due impartiality lies at the heart of the BBC. It is a core value and no area of programming is exempt from it".
      The thrust of the Complaints Unit's reply was that it was outside their remit, unless there was a case to be argued for irresponsibility or potential harm. This, they said, is because the BBC's duty of due impartiality only applies to "matters of public policy or of political and industrial controversy". This seemed bizarre, and I queried it. Didn't their guideline say "no area of programming is exempt"? But no, they replied, the duty of due impartiality "applies to all areas only in the sense that no area of programming is exempt from it when dealing with matters where due impartiality is required"! This duty derives, they said, from section 5 of the Agreement associated with the BBC Charter.
      In short, despite apparent stated commitment to overall impartiality, the small print is that it applies selectively and that there is nothing you can actually hold them to to enforce it outside that selective area.

As I described in 2005 - OK to promote vegetables via nonsense? - I had similar problems with Ofcom, the UK independent regulator for telecommunications. Having noticed in their archives a failed Accuracy complaint ("not in breach/out of remit") about Gillian McKeith's You are What You Eat, I asked if any part of their Code covered scientific inaccuracies in such programmes. No, they said. Viewers being 'misled' is in their brief where it relates to advertising or news bulletins, but "In matters of science it is invariably the case that there are a range of views on any number of issues ... Ofcom's primary concern as a regulator is not for scientific accuracy in the face of alternate views, but rather that care has been taken by the broadcaster to avoid harm". Here are the Harm and Offence and Due Impartiality and Due Accuracy and Undue Prominence of Views and Opinions sections of their Broadcasting Code, you find there is nothing enforcing accuracy, and impartiality only applies to "matters of political or industrial controversy and matters relating to current public policy".
      To sum up, if you see bad science aired on UK television, you will run into serious difficulties in getting complaints to stick if you're arguing faults of accuracy or balance. You need to argue harm.

Wednesday, 26 September 2007

Smells of breathalyser myth

The Sun on September 22 carried a sensational story, Prince Harry snorts vodka: "BOOZE-loving Prince Harry was blasted last night for snorting VODKA in a potentially lethal drinking game". Some of the medical backup to the sensationalism, however, looked iffy: "Professor Ian Gilmore, president of the Royal College of Physicians, explained that snorting alcohol meant it was absorbed directly through the lungs — bypassing the liver. He warned bluntly: 'This could kill'. Alcohol Concern’s Frank Soodeen said: 'There is nothing cool or glamorous about snorting alcohol. The medical view is clear. Taking alcohol up the nose increases the risk of direct alcohol damage to the brain'".
      Not exactly: it first bypasses the stomach, where initial detoxification takes place through the alcohol dehydrogenase in the stomach lining. Even after this, when blood from the stomach goes to the liver via the portal vein, only part of the alcohol is dealt with on the first pass (otherwise it'd be impossible to get drunk) and it's progressively swept up each time it goes round.
      It's fair to say that this is a way of getting alcohol into your system fast, and there's a risk of overdose if you choose to ingest alcohol very rapidly (whether by sniffing it or knocking back shots in quick succession). However, this story taps into a strange myth that sniffed or inhaled alcohol mysteriously goes direct to the brain without getting into the body at large. For instance, Experts blast 'snorting alcohol' craze quotes Professor Oliver James, head of clinical medical sciences at Newcastle University: "He added that people may also be able to inhale alcohol for 20 minutes, get drunk, drive and still be able to pass a police breathalyser test as alcohol levels in the blood remained very low". The BBC story Inhaling alcohol may 'harm brain' repeated the same quote. I wonder if he's being quoted out of context, because the physiology of this is plain wrong. However you take alcohol, it goes into the bloodstream and the brain gets it by that route; there's no way to target the brain exclusively and be drunk without corresponding blood alcohol levels. The story has been repeated, for instance, at the site of Susan Westrom, 79th District Kentucky State Representive.
      As to the dangers, there are other views. The Guardian Science section referred to this practice in 2004 - Is sniffing alcohol bad for you? - consulting Professor Alastair Hay of Leeds University, one of Britain's foremost toxicologists, with the conclusion "Probably not, well no worse than drinking it anyway". He did warn, however, that the irritant and defatting action of alcohol might long term produce "some pathology" to the nasal passages. This is why, as The Sun says, "He throws back his head to take the full 'hit' of vodka — and then reels in shock. The Prince is seen shuddering as his friends cheer". It's not the alcoholic hit, but simply that it's seriously painful, which seems plenty reason not to do it.
      There's no doubt that excessive alcohol consumption isn't good for you, but alcohol safety initiatives aren't helped by spreading scary falsehoods. Alcohol: Problems and Solutions makes interesting reading. Its creator, Professor David J. Hanson, is an eminent researcher and expert on alcohol-related topics, and he cites a number of alcohol myths and various scare stories, such as "alcohol is a solvent" (as are "water, olive oil, vinegar, milk and almost all other liquids"), that are similar if not identical to those of 19th century Temperance campaigners.

Bringing Up Baby - theatre or bad science?

Yesterday, Channel 4 screened the first episode of Bringing Up Baby, a series which purports to compare three childcare theories - Truby King, Dr Spock, and the Continuum Concept - by testing them in practice. I say "purports" because these days it's anyone's guess whether shows are real or to some extent theatrical contrivance. Check out, for instance, the revelations that Bear Grylls in Born Survivor, for reasons of health and safety, had a deal of help in surviving; and that in Dumped, for the same reasons, the participants were living on a simulated rubbish dump.
      Bringing Up Baby is already attracting a deal of comment because one of its mentors, the nurse and celebrity consultant Claire Verity, aka The Baby Guru, is an exponent of the methods advocated by Sir Frederic Truby King. While his career was highly worthy in respect of raising consciousness about child welfare and lowering infant mortality, his agenda was essentially nationalistic, imperialist and driven by eugenics, and he was at the core of a celebrity following largely based on ideas of racial improvement. The fetishistic detail of this 'Plunket system' (named after Victoria Plunket, an early patron) raised eyebrows even in its time; Dr Helen Mayo, head of Adelaide's voluntary infant welfare movement, wrote "The chief drawback of the Plunket system is the fanaticism of the nurses; it becomes practically a religious cult with them". (See A History of Australia, New Zealand, and the Pacific). Indeed, the biography at the Dictionary of New Zealand Biography describes Truby King himself as rather disorganised, and says the obsessive organisation came from the system's interpreters.

The controversial aspect in relation to Bringing Up Baby is Truby King's childcare method. Living at Scarba (PDF), an account of an Australian childcare home, describes it: Early 20th century childcare theory and practice was marked by a desire to 'grow superior children'. In the early 1920s the theories of Frederic Truby King (New Zealand) and John B. Watson (USA), who were both initially involved in the study of animals, dominated infant care theory. In general their theories encouraged parents or carers to train children to become independent, self-reliant, self-controlled and unemotional. It was thought that the removal of love and affection would enable children to become industrious, enterprising and resourceful ... Truby King advocated for children to have strict routines and regimented lives – habit training – which included regular, if not obsessive, times for feeding, exercise and sleeping. Furthermore, Truby King, along with other child experts, believed babies both preferred and benefited from solitude.
      The regime, then, involves no touching, minimal eye contact, leaving the infant alone for long periods, and so on. This goes radically against the modern view, informed by knowledge of infant neurobiological development, that early mother-infant bonding is crucial. See Bonding and Attachment in Maltreated Children: Consequences of Emotional Neglect in Childhood, which stresses the importance of activities such as "holding, rocking, singing, feeding, gazing, kissing, and other nurturing behaviors ... the most important factor in creating attachment is positive physical contact". Against this, Truby King's system has been long discredited.

As explored in this article reprinted at The Children's Project - Promoting Resilience: Changing Concepts of Parenting and Child Care - the history of changing theories on childcare is an interesting and worthwhile topic that deserves television airtime. Nevertheless, the ethics of testing on babies a system that is based on an archaic and harmful premise is questionable to say the least. The Channel 4 Family forum topic is currently quite busy on the topic, and the view of Claire Verity / Truby King methods is uniformly hostile.
      OK, so maybe I'm being naive about TV production, and maybe we're all being sucked into a non-controversy about a programme that's obviously a construct to dramatise these theories (Truby King vs Spock vs Continuum played out as caricatures: Control Freak vs Dated-but-Laidback vs Drippy New Age). I hope so, but we should be told if this is the case (the issue of faked TV scenarios is currently a hot topic in itself). Claire Verity, however, appears to be serious, and whether the scenario is real or concocted, I think it's irresponsible for Channel 4 to publicise a theory that's so out of tune not merely with childcare fashion, but with established developmental science.
      I'm pleased to see that Social Baby, the weblog of Helen and Clive Dorman (authors and co-founders of The Children's Project), is already well on the case, arguing that the use of the Truby King method may even be a breach of the Unicef Convention on the Rights of the Child. They in fact were contacted, when the programme makers were looking for proponents of the method, and provided plenty of evidence that it was discredited and plain damaging - but the programme went ahead anyway. The whole thing was filmed months back, of course - in May 2007, according to a Birmingham Sunday Mercury piece - so complaints are little belated.


At the excellent Bad Science, Ben Goldacre has instigated a collective project, BadScienceBlogs, encouraging the many prolific contributors to the Bad Science forums to set up their own blogs, which BadScienceBlogs will aggregate. I don't exclusively cover Bad Science topics at my other more eclectic weblog, The Apothecary's Drawer, so I've decided to split off content; this one is where the "poor pothecary" (as in Romeo and Juliet) dispenses poison.