Hippotherapy

In Bad Science circles, a regular gripe is the BBC providing what is in effect advertorial for unproven therapies via news items with little or no balance. For instance, A canna' change the laws of physics just posted See The Light, a critique of unquestioning TV coverage of a dubious light therapy for Seasonal; Affective Depression.
Along those lines, BBC's online health section just featured 'Horse therapy helped my daughter', an account of a child with cerebral palsy being treated with "hippotherapy", a physio technique in which "Treatment involves putting patients on horseback in a variety of positions and adapting to the horse's movements and working on co-ordination and posture". This is not the well-established Riding for the disabled, an activity of clear benefits in terms of enjoyment, fitness and independence. In hippotherapy, the rider doesn't control the horse (and indeed might sit facing backwards). A therapist leads the horse around, and the claim is that keeping balance in relation to the specific 3D movement of the horse provides neurological benefits.
While I suppose the intention is to provide a harmless human interest story, the BBC coverage is largely uncritical. In the token criticism section at the end, a spokesperson for Scope (the cerebral palsy charity) comments that while horse-riding is relaxing, hippotherapy shouldn't be viewed as a cure for cerebral palsy. Nevertheless, the piece completely fails to analyse the problems of proving claims made for hippotherapy.
Compare and contrast, then, Horse Power: When Riding Turns Into Treatment, hosted at the American Hippotherapy Association's own website, and Hippotherapy explained at the American Equestrian Alliance website. Both of these are reasonably-balanced articles that describe the claims for hippotherapy, but also are very clear about the lack of evidence-based research and the problems of measuring any benefits objectively.
The Research and Training Center (RTC) on Early Childhood Development, which focuses on evidence-based practice in the childhood development field, has a review paper, Influences of Hippotherapy on the Motor and Social-Emotional Behavior of Young Children with Disabilities (PDF) by Pamela S. Rolandelli and Carl J. Dunst, analysing the general faultiness of studies into hippotherapy. Its findings, summarised in a terser article, Saddle up, but... (PDF), are that "Most studies reported some positive physical, language, or social-emotional effects for hippotherapy study participants. As a whole, however, the RTC researchers found that the studies were not conducted with the kind of scientific rigor needed to conclude that hippotherapy was responsible for the observed improvements".
You won't find any link to such counterevidence at the BBC story.

High-tech scan meets questionable diagnosis model

An example of what slips into the news without critical examination: from the BBC, Scans reveal lost gravestone text. This is an interesting feature about work by the Ambient Intelligence Group at Carnegie Mellon University using a combination of 3D scans and image processing to recover eroded and/or overgrown texts. That's the good science. But there's an incongruous aside, mentioned twice: "The technique could one day also be used by doctors to examine a patient's tongue for signs of illness ... Dr Cai said: 'We may use the technology ... to ... help medical doctors to diagnose patients' well-being through tongue inspection'. Whatever's that about?
      A little Googling finds it concerns A Novel Imaging System for Tongue Inspection (PDF). We're talking traditional Chinese medicine - TCM - which places significance on tongue diagnosis. This patent, Method of extracting region of interest from tongue image and health monitoring method and apparatus using the tongue image, shows a deal of work has been expended toward high-tech embellishment of this technique. Needless to say, TCM's detailed model based on the tongue mirroring various parts of the body and producing diagnoses such as liver qi stagnation or heart yin deficiency is not part of mainstream Western medicine.
      Of course, it's possible that the overall edifice is daft but there still could be specific correlations between the tongue and some conditions; as Embarrassingproblems.com mentions, a smooth, red, sore tongue can be a sign of anaemia. Yang Cai is investigating, he says sceptically, the possibility that tongue appearance may correlate with cancer, providing a non-invasive diagnostic method. However, much of the preliminary evidence comes from Chinese partisan journals such as the TCM Diagnosis Association and China TCM Society and, unfortunately, China is one of the places where published clinical trials almost invariably report positive results. So it's probably best to wait until it appears in the BMJ or similar.
      More about the story at Carnegie Mellon Magazine: East Meets West / Tongue Tells Health Tales.

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.