Why researchers have a duty to try and influence policy

Simon Chapman, University of Sydney

Very early in my career, I was invited to afternoon tea with the head of the Commonwealth Institute of Health at Sydney University, where I worked. The best bone china was produced and pleasantries exchanged. The agenda soon became clear.

He laboured into a parable about the difference between young and old bulls when locked in a small yard. He told me young bulls run hard at the gate, exhausting and sometimes harming themselves.

But old bulls are generally patient and placid. They always know the farmer will open the gate and they’ll walk out and soon get among the pasture and the cows.

Young bulls should learn from old bulls, he told me.

I knew exactly why he’d called me. For some months, I’d been in the forefront of a small group of public health people who were confronting the advertising industry’s self-regulation body with data about the appeal of Paul Hogan, who fronted the massively successful Winfield cigarette advertising campaign. Hogan’s own TV program had huge appeal to children. The advertising campaign was, therefore, in flagrant breach of the industry’s own guidelines and so needed to be stopped.

After 18 months of trying to ignore us, we won. We quickly discovered while the advertising industry could ignore our letters, going public turned 10,000 watt arc lights on the self-regulation farce. Over that time the media often interviewed us. A headline after we won said our slingshot had cut down the advertising ogre. Hogan said he’d been sent from the field for kicking too many goals. That was in fact our argument.

My “young and old bulls” mentor later told me he’d been tapped by the Vice Chancellor to tighten the reins, after receiving complaints from connections with the tobacco industry.

Then, and even today, there still remain large remnants of the attitude in universities that scientists and researchers should avoid talking to the media. News media are frequently disdained by academics as trivialising and superficial, something from which those with ambitions of gravitas should keep well away.

A long history

The roots of this go way back. In 1905 Sir William Osler a foundation professor at Baltimore’s Johns Hopkins Hospital, warned against “dallying with the Delilah of the press”. More than 100 years later, a 2006 report by the UK Royal Society noted 20% of UK scientists believed colleagues who engage with the media are “less well regarded” by their peers.

Public engagement was something “done by those who were ‘not good enough’ for an academic career”. Those who did so were seen by some as “light” or “fluffy” and, wait for this, more likely to be women. While 60% of UK researchers wanted to engage with politicians about their research, far fewer (31%) wanted to engage with journalists.

The cocooned naivety of this position is quite staggering.

Knowing someone, but never meeting

Early in Nicola Roxon’s tenure as Australian health minister I approached her after a talk she gave at a conference. “I don’t think we’ve ever met,” I said. “No, but I feel I’ve known you all my adult life,” she replied.

This could have only meant she knew me through the media.

There is an abundance of research showing people get a huge amount of their information and understanding of health issues from the news media. Equally, most politicians and their advisors rarely read scholarly papers in research journals. They form their understandings of the issues in their portfolio in a variety of ways. But like us all, they are daily exposed to information and discussion about health and medicine through the media they consume voraciously every day.

I had an instinct about the importance of all this right from the beginning of my career and so quickly took to trying to get my research covered in the media; I gave high priority to making room in my day to provide commentary about the areas in which I worked.

Here, I quickly learned the constraints on time and space meant something richly nuanced and complex always needed to be condensed into just two or three sentences in print media reports, or 7.2 seconds in television news. When I started taking opportunities to write opinion page and feature articles, the access to my work and commentary on controversies in public health rapidly accelerated.

Visibility brings access

The visibility this brought opened many doors to senior policy advisors and politicians. I also frequently had the experience of dozens of people telling me across a day they had read and enjoyed a piece I’d written in a newspaper that morning, or a breakfast radio interview as they got ready for work. Most of these colleagues work in adjacent areas of public health and would have only occasionally read my research work in journals.

My own GP and other clinicians have often told me about patients who brought in one of my newspaper articles to ask about it. This was especially true about pieces I wrote on the risks and benefits of prostate cancer screening. This feedback inspired a 2010 book – Let Sleeping Dogs Lie?: what men should know before getting tested for prostate cancer. Colleagues and I published it as a free ebook and it’s been downloaded over 35,000 times.

My 85 articles in The Conversation have been read over two and a half million times. Just two of them have together been read over 1.8 million times. By contrast, the most read of over 500 papers I’ve published in peer reviewed journals has been read only 150,000 times. Many are lucky to get even 5000 readers. Being locked behind subscription paywalls doesn’t help.

Who are the ‘influencers’?

A few years ago, colleagues and I researched the characteristics associated with peer-voted “influential” researchers. We invited all Australian researchers who had published 10 or more papers in particular fields of public health to name five Australian researchers who were “most influential” in each of these fields. We then interviewed the top five from each field.

Overwhelmingly, nearly all said they believed researchers had a responsibility and even a duty to produce work that might help shape policy and practice. Most of these were very comfortable in actively pursuing media opportunities to bring understanding of their work to the public. Those who weren’t comfortable in the media were very happy for others to do this on their behalf.

This approach started with choosing research questions they hoped would provide strategically useful information to inform policy. Their approach then passed through the necessary steps of grant application craft to best ensure it was funded through the highly competitive National Health and Medical Research Council process that now sees only 17% of applications funded.

These two steps are meat and potatoes for all funded research.

But it was in post-publication behaviour where influential researchers differ. They actively promote their work – not just to other colleagues in seminars and conferences, but to the public and those who might act on it politically.

And after all, isn’t helping evidence-based policy and practice the whole point of wanting to do the research in the first place? Why else would you bother?

Don’t just ‘stick to the facts’

Some critics of researchers with media profiles argue researchers should just “stick to the facts” in media interviews. Our study participants saw this as naïve because “people always want to know what the policy implications are”.

A total of 94% of those we interviewed disagreed with the view it was inappropriate to express opinions in the media about public health policy. Journalists might begin with a research finding or an expert clarification of a new report. But they invariably then asked what needed to be “done” about the problem, typically by government.

Journalists and audiences would meet with incredulity any researcher who tried to end an interview when there were questions about policy reform “oughts”, or claimed to have no opinion on what should be done. We expect those who know most about health problems to have views about what should be done to solve them and the courage to put these forward, even if they imply criticism of governments or powerful interest groups.

Speak up, speak up

Trump’s recent gagging of all government environmental agency staff is surely the start of a process that will spread to government funded universities in the USA. There has never been a more important time for researchers all over the world to speak up about their work, it’s implications and how societies and governments should act on it.

I’ve just published a collection of 71 of my essays and op eds across a large variety of public health issues. Like this column, the book is called Smoke Signals, and is published by the Sydney University Press imprint, Darlington Press. It’s available in paperback or as an ebook.

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This article will be the subject of ABC Radio National’s Ockham’s Razor on Sunday, February 26, 2017 at 7.45am.

Simon Chapman, Emeritus Professor in Public Health, University of Sydney

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

NHMRC fluoride paper: relax, Australian citizens, your pineal glands are safe

Michael Vagg, Deakin University

When not being forced to waste their time and formidable expertise researching furphies like wind turbine syndrome or homeopathy, the National Health and Medical Research Council (NHMRC) can get on with producing exemplary public health statements like their newest one on water fluoridation.

Begun in 2014 in response to this sort of conspiracy-mongering, the NHMRC has collected an overwhelming weight of evidence in support of the safety and benefit of adding tiny amounts of fluoride to drinking water supplies.

This document is a draft released for public comment. I would love to be able to read the public submissions they are going to get. None of the favoured conspiracy claims are supported.

It most emphatically did not find any evidence that fluoride lowers IQ, as suggested by a badly done and even more badly reported paper from 2012.

Neither did it find any support for the idea that fluoride at levels obtained by current fluoridation practices caused significant dental fluorosis, such as brittle or discoloured teeth from excessive fluoride being incorporated into teeth.

Still less was there any support for fluoride acting as a mind control agent!

The draft paper sets out in excellent prose the value of its work and how it has been done. It is easy to understand and reading through it, I was struck by how well the considerable scientific grunt work had been made to sound easy and logical. In particular, the couple of pages the authors have devoted to their methodology is outstandingly clear and easily understood.

Sections are also included on the ethics and cost-effectiveness of water fluoridation, distilled into useful factoids such as:

• For every A$1 spent on fluoridation, A$7-18 is saved in dental treatment costs
• Over the last 25 years in Victoria, around A$1 billion dollars has been saved in treatment costs and reduced absenteeism
• Stopping water fluoridation would increase health inequality in the nation as a whole.

I would recommend the NHMRC fluoride paper as a public document for anyone with an interest in the issue, or indeed as a basic study of how to do public health policy. Most people I suspect will just go about their lives secure in the knowledge that sensible, reasonable public health professionals are making good decisions in the national interest.

Or at least, that’s what we would be thinking given that we are apparently docile and obedient from all the fluoride accumulating in our pineal glands…

Michael Vagg, Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist, Deakin University

This article was originally published on The Conversation. Read the original article.

 

The Fallacy of Faulty Risk Assessment

by Tim Harding

(An edited version of this essay was published in The Skeptic magazine, September 2016, Vol 36 No 3)

Australian Skeptics have tackled many false beliefs over the years, often in co-operation with other organisations.  We have had some successes – for instance, belief in homeopathy finally seems to be on the wane.  Nevertheless, false beliefs about vaccination and fluoridation just won’t lie down and die – despite concerted campaigns by medical practitioners, dentists, governments and more recently the media.  Why are these beliefs so immune to evidence and arguments?

There are several possible explanations for the persistence of these false beliefs.  One is denialism – the rejection of established facts in favour of personal opinions.  Closely related are conspiracy theories, which typically allege that facts have been suppressed or fabricated by ‘the powers that be’, in an attempt by denialists to explain the discrepancies between their opinions and the findings of science.  A third possibility is an error of reasoning or fallacy known as Faulty Risk Assessment, which is the topic of this article.

Before going on to discuss vaccination and fluoridation in terms of this fallacy, I would like to talk about risk and risk assessment in general.

What is risk assessment?

Hardly anything we do in life is risk-free. Whenever we travel in a car or even walk along a footpath, most people are aware that there is a small but finite risk of being injured or killed.  Yet this risk does not keep us away from roads.  We intuitively make an informal risk assessment that the level of this risk is acceptable in the circumstances.

In more formal terms, ‘risk’ may be defined as the probability or likelihood of something bad happening multiplied by the resulting cost/benefit ratio if it does happen.  Risk analysis is the process of discovering what risks are associated with a particular hazard, including the mechanisms that cause the hazard, then estimating the likelihood that the hazard will occur and the consequences if it does occur.

Risk assessment is the determination of the acceptability of risk using two dimensions of measurement – the likelihood of an adverse event occurring; and the severity of the consequences if it does occur, as illustrated in the diagram below.  (This two-dimensional risk assessment is a conceptually useful way of ranking risks, even if one or both of the dimensions cannot be measured quantitatively).

By way of illustration, the likelihood of something bad happening could be very low, but the consequences could be unacceptably high – enough to justify preventative action.  Conversely, the likelihood of an event could be higher, but the consequences could low enough to justify ‘taking the risk’.

In assessing the consequences, consideration needs to be given to the size of the population likely to be affected, and the severity of the impact on those affected.  This will provide an indication of the aggregate effect of an adverse event.  For example, ‘high’ consequences might include significant harm to a small group of affected individuals, or moderate harm to a large number of individuals.

A fallacy is committed when a person either focuses on the risks of an activity and ignores its benefits; and/or takes account one dimension of risk assessment and overlooks the other dimension.

To give a practical example of a one-dimensional risk assessment, the desalination plant to augment Melbourne’s water supply has been called a ‘white elephant’ by some people, because it has not been needed since the last drought broke in March 2010.  But this criticism ignores the catastrophic consequences that could have occurred had the drought not broken.  In June 2009, Melbourne’s water storages fell to 25.5% of capacity, the lowest level since the huge Thomson Dam began filling in 1984.  This downward trend could have continued at that time, and could well be repeated during the inevitable next drought.

Melbourne’s desalination plant at Wonthaggi

No responsible government could afford to ‘take the risk’ of a major city of more than four million people running out of water.  People in temperate climates can survive without electricity or gas, but are likely to die of thirst in less than a week without water, not to mention the hygiene crisis that would occur without washing or toilet flushing.  The failure to safeguard the water supply of a major city is one of the most serious derelictions of government responsibility imaginable.

Turning now to the anti-vaccination and anti-fluoridation movements, they both commit the fallacy of Faulty Risk Assessment.  They focus on the very tiny likelihood of adverse side effects without considering the major benefits to public health from vaccination and the fluoridation of public water supplies, and the potentially severe consequences of not vaccinating or fluoridating.

Vaccination risks

The benefits of vaccination far outweigh its risks for all of the diseases where vaccines are available.  This includes influenza, pertussis (whooping cough), measles and tetanus – not to mention the terrible diseases that vaccination has eradicated from Australia such as smallpox, polio, diphtheria and tuberculosis.

As fellow skeptic Dr. Rachael Dunlop puts it:  ‘In many ways, vaccines are a victim of their own success, leading us to forget just how debilitating preventable diseases can be – not seeing kids in calipers or hospital wards full of iron lungs means we forget just how serious these diseases can be.’

No adult or teenager has ever died or become seriously ill in Australia from the side effects of vaccination; yet large numbers of people have died from the lack of vaccination.  The notorious Wakefield allegation in 1998 of a link between vaccination and autism has been discredited, retracted and found to be fraudulent.  Further evidence comes from a recently published exhaustive review examining 12,000 research articles covering eight different vaccines which also concluded there is no link between vaccines and autism.

According to Professor C Raina MacIntyre of UNSW, ‘Influenza virus is a serious infection, which causes 1,500 to 3,500 deaths in Australia each year.  Death occurs from direct viral effects (such as viral pneumonia) or from complications such as bacterial pneumonia and other secondary bacterial infections. In people with underlying coronary artery disease, influenza may also precipitate heart attacks, which flu vaccine may prevent.’

In 2010, increased rates of high fever and febrile convulsions were reported in children under 5 years of age after they were vaccinated with the Fluvax vaccine.  This vaccine has not been registered for use in this age group since late 2010 and therefore should not be given to children under 5 years of age. The available data indicate that there is a very low risk of fever, which is usually mild and transient, following vaccination with the other vaccine brands.  Any of these other vaccines can be used in children aged 6 months and older.

Australia was declared measles-free in 2005 by the World Health Organization (WHO) – before we stopped being so vigilant about vaccinating and outbreaks began to reappear.  The impact of vaccine complacency can be observed in the 2015 measles epidemic in Wales where there were over 800 cases and one death, and many people presenting were of the age who missed out on MMR vaccination following the Wakefield scare.

After the link to autism was disproven, many anti-vaxers shifted the blame to thiomersal, a mercury-containing component of relatively low toxicity to humans.  Small amounts of thiomersal were used as a preservative in some vaccines, but not the MMR vaccine.  Thiomersal was removed from all scheduled childhood vaccines in 2000.

In terms of risk assessment, Dr. Dunlop has pointed out that no vaccine is 100% effective and vaccines are not an absolute guarantee against infection. So while it’s still possible to get the disease you’ve been vaccinated against, disease severity and duration will be reduced.  Those who are vaccinated have fewer complications than people who aren’t.  With pertussis (whooping cough), for example, severe complications such as pneumonia and encephalitis (brain inflammation) occur almost exclusively in the unvaccinated.  So since the majority of the population is vaccinated, it follows that most people who get a particular disease will be vaccinated, but critically, they will suffer fewer complications and long-term effects than those who are completely unprotected.

Fluoridation risks

Public water fluoridation is the adjustment of the natural levels of fluoride in drinking water to a level that helps protect teeth against decay.  In many (but not all) parts of Australia, reticulated drinking water has been fluoridated since the early 1960s.

The benefits of fluoridation are well documented.  In November 2007, the NHMRC completed a review of the latest scientific evidence in relation to fluoride and health.  Based on this review, the NHMRC recommended community water fluoridation programs as the most effective and socially equitable community measure for protecting the population from tooth decay.  The scientific and medical support for the benefits of fluoridation certainly outweighs the claims of the vocal minority against it.

Fluoridation opponents over the years have claimed that putting fluoride in water causes health problems, is too expensive and is a form of mass medication.  Some conspiracy theorists go as far as to suggest that fluoridation is a communist plot to lower children’s IQ.  Yet, there is no evidence of any adverse health effects from the fluoridation of water at the recommended levels.  The only possible risk is from over-dosing water supplies as a result of automated equipment failure, but there is inline testing of fluoride levels with automated water shutoffs in the remote event of overdosing.  Any overdose would need to be massive to have any adverse effect on health.  The probability of such a massive overdose is extremely low.

Tooth decay remains a significant problem. In Victoria, for instance, more than 4,400 children under 10, including 197 two-year-olds and 828 four-year-olds, required general anaesthetic in hospital for the treatment of dental decay during 2009-10.  Indeed, 95% of all preventable dental admissions to hospital for children up to nine years old in Victoria are due to dental decay. Children under ten in non-optimally fluoridated areas are twice as likely to require a general anaesthetic for treatment of dental decay as children in optimally fluoridated areas.

As fellow skeptic and pain management specialist Dr. Michael Vagg has said, “The risks of general anaesthesia for multiple tooth extractions are not to be idly contemplated for children, and far outweigh the virtually non-existent risk from fluoridation.”  So in terms of risk assessment, the risks from not fluoridating water supplies are far greater than the risks of fluoridating.

Implications for skeptical activism

Anti-vaxers and anti-fluoridationists who are motivated by denialism and conspiracy theories tend to believe whatever they want to believe, and dogmatically so.  Thus evidence and arguments are unlikely to have much influence on them.

But not all anti-vaxxers and anti-fluoridationists fall into this category.  Some may have been misled by false information, and thus could possibly be open to persuasion if the correct information is provided.

Others might even be aware of the correct information, but are assessing the risks fallaciously in the ways I have described in this article.  Their errors are not ones of fact, but errors of reasoning.  They too might be open to persuasion if education about sound risk assessment is provided.

I hope that analysing the false beliefs about vaccination and fluoridation from the perspective of the Faulty Risk Assessment Fallacy has provided yet another weapon in the skeptical armoury against these false beliefs.

References

Rachael Dunlop (2015) Six myths about vaccination – and why they’re wrong. The Conversation, Parkville.

C Raina MacIntyre (2016) Thinking about getting the 2016 flu vaccine? Here’s what you need to know. The Conversation, Parkville.

Mike Morgan (2012) How fluoride in water helps prevent tooth decay.  The Conversation, Parkville.

Michael Vagg (2013) Fluoride conspiracies + activism = harm to children. The Conversation, Parkville.

 Government of Victoria (2014) Victorian Guide to Regulation. Department of Treasury and Finance, Melbourne.

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Governments shouldn’t be able to censor research results they don’t like

Kypros Kypri, University of Newcastle

Government departments and agencies routinely commission research to help them understand and respond to health, social and other problems. We expect such research to be impartial and unbiased. But governments impose legal conditions on such research that can subvert science and the public interest.

Gagging clauses in contracts permit purchasers of research to modify, substantially delay, or prohibit the reporting of findings.

A 2006 survey of health scientists in Australia shows such clauses have been invoked by our federal and state governments to sanitise the reporting of “failings in health services … the health status of a vulnerable group … or … harm in the environment …”. And in a paper published today in the Medical Journal of Australia, I describe my experience of a contract negotiation with a government department where gagging clauses became an issue.

A rude shock

My colleagues and I were pretty happy when we were notified that our application for funding to study a new treatment for risky drinking had been successful. But then we received a draft contract with clauses that could potentially be used to sanitise the study findings, prohibit publication, or even terminate the project without notice or explanation via a “Termination for Convenience” clause.

That experience led us to initiate a formal study of the kinds of contracts governments use to purchase public good research in Australia. Draft contracts obtained through the Commonwealth’s AusTender website and its state equivalents show these documents often contain gagging clauses. And informal enquiries with universities suggest that Termination for Convenience clauses are common and accepted within the sector as a “cost of doing business” with government.

It’s important to note that these concerns don’t pertain to specialist funders of science such as the Australian Research Council and the National Health and Medical Research Council. What I am talking about here are government agencies that commission research to guide their activities and policy advice to government.

And while my area of expertise is health science, a brief examination of tenders for research in other domains suggests that gagging clauses are not unique to health.

Universities as the conscience of society

Private companies that provide research services to governments are motivated by profit, rather than public good, and may have no problem with accepting gagging clauses as long as they’re paid. But universities have ethical and legal obligations to serve the public interest.

A noteworthy aspect of my contract negotiation was that the university involved would probably have signed the restrictive contract offered. The experience of other health scientists and the government department’s comment in my case that the contract was standard (essentially asking what were we complaining about) suggest such arrangements are the norm.

But the idea that academics should be frank and fearless in their reporting and commentary is codified in the acts of parliament used to establish our universities, as well as in the Commonwealth’s Tertiary Education Quality and Standards Agency Act 2011:

The higher education provider protects academic integrity in higher education through effective policies and measures to: … ensure the integrity of research and research activity; [and] ensure that academic staff are free to make public comment on issues that lie within their area of expertise…

Universities have an obligation to the public and should be careful when faced with gagging clauses. Juli/Flickr, CC BY

Some reasons why

So how has this culture of suppression come about? I hypothesise four processes underpinning this phenomenon:

1) Governments are increasingly image-conscious and active in managing the information environment. Research seems to have become more a means of providing support for a policy position than for generating knowledge to guide policy.

2) Lawyers with experience in the corporate environment are more often being employed in government, drafting contracts that are adversarial in character where they used to be cooperative. A similar proclivity to employ lawyers from the corporate world in university research offices may have contributed to loss of institutional memory about universities’ conscience of society role.

3) The squeeze on research funding from dedicated sources, such as the ARC and the NHMRC, has encouraged universities to compete more for government contracts.

4) Casualisation of the research workforce means people undertaking research are less able to be choosy about the kinds of projects they undertake.

Embracing partnership

In his seminal paper The Experimenting Society, Donald Campbell lamented the tendency of mid-20th-century American governments to commit to certain policy positions in the absence of evidence, rather than trying to generate the knowledge necessary to underpin better policy.

Similarly, Australian governments undertake policy experiments of one sort or another, perhaps every week, yet little is learned from them. These need to be recognised as opportunities to extend knowledge of how to generate wealth and well-being, and address society’s problems.

But that will require a change in the orientation of governments to recognising the need for evidence-based policy and, where evidence is inadequate, to contribute to generating relevant evidence through ethical funding of public good research. Effective partnership with scientists in the planning of evaluation is needed to accomplish that.

In turn, universities must revisit their founding principles, which include obligations to undertake research that benefits the public they are funded to serve, and to protect and encourage the role of public advocacy.

To be effective, there needs to be a sector-wide effort to modify the way governments purchase research. Situations in which secrecy about findings would be warranted would surely be rare and require strong justification.

Kypros Kypri is Professor, Public Health, Epidemiology & Prevention of Alcohol-related Injury and Disease at University of Newcastle.

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

Alternative medicine can be scientific, say besieged academics

Matthew Thompson, The Conversation

RMIT University’s School of Health Sciences has rejected the suggestion that it peddles pseudo-scientific quackery via its courses in complementary and alternative medicine (CAM).

Acting head of the school Dr Ray Myers has defended RMIT’s health science programs as “evidence-based education and practice”, citing collaboration in clinical research of CAM treatments funded by the National Health and Medical Research Council (NHMRC).

Dr Myers was speaking in the face of a campaign by a coalition of prominent medical researchers to expunge higher education of the “undisciplined nonsense” taught in CAM courses at Australia’s “somewhat lesser universities”.

The campaigning group, Friends of Science in Medicine (FSM), has about 400 signatories, including immunologist Sir Gustav Nossal and Professor Jock Findlay, chairman of the NHMRC’s Embryo Research Licensing Committee. It has written to every vice-chancellor in Australia asking for a review of their health science courses to “ensure that primacy is given to scientific principles based on experimental evidence”. The letter laments the spread of chiropractic studies to 19 Australian universities, and complains that ‘energy medicine’, ‘tactile healing’, homeopathy, iridology, kinesiology, acupuncture, and reflexology are taught “as if they were science”.

Group co-founder Emeritus Professor John Dwyer from the University of NSW said that FSM wants “vice-chancellors to ask their deans of science what’s the heck’s going on … It’s just extraordinary that such undisciplined nonsense is being taught in universities around Australia.”

“One of the complaints that we have about so-called alternative medicine is that it doesn’t strive to be tested. … modern medicine is totally devoted to doing everything we can to take this evidence-based approach and do good science and do good research into the things we do to people,” he said. “Alternative medicine doesn’t do that – it’s more than happy to rely on tradition and anecdote and it doesn’t really want to be tested.”

However, Dr Myers said that CAM research at RMIT was conducted in a thoroughly scientific manner, with the NHMRC funding clinical trials of alternative medicines. In a clinical study granted A$560,000 by the NHMRC and A$30,000 by the National Institute of Complementary Medicine, the university was collaborating with two Melbourne hospitals on a clinical study investigating the use of ginseng, a herb used in traditional Chinese medicine, for improving lung function in patients with Chronic Obstructive Pulmonary Disease (COPD), he said.

The NHMRC had also granted A$400,000 for a project in which the university was collaborating with three Melbourne hospitals on a three-year clinical trial of acupuncture for pain management in emergency departments, Dr Myers said. “The project follows the promising results of pilot studies by RMIT researchers, in which more than 1,000 patients received acupuncture treatment for acute pain relief at the emergency department of the Northern Hospital.”

The professions of Chinese medicine, chiropractic and osteopathy are government regulated, Dr Myers said, with RMIT programs in these fields meeting current professional standards and subject to external accreditation. Chiropractic and osteopathy were areas in which clinical research was limited, but RMIT’s education program incorporated the “best available evidence, while promoting further clinical research into these treatments,” Dr Myers said. “RMIT stands by its long record of evidence-based research and the high quality of its health sciences programs.”

But FSM is not buying it. “Those universities involved in teaching pseudoscience give such ideologies undeserved credibility, damage their academic standing and put the public at risk,” the group’s letter states.

The great danger, said Professor Dwyer, was that people who have chronic health problems or who have been persuaded that doctors do not have the answers are delaying the “proper investigation and treatment” of their illness by instead seeking help from therapists offering alternative medicine.

“These are dangerous delusions, and our campaign at the moment is aimed at those somewhat lesser universities, but nonetheless universities, that are offering and teaching pseudoscience as if there was an evidence base to support it, because obviously that gives credibility in the eye of the public,” Professor Dwyer said.

Citing the late CEO of Apple, Professor Dwyer said that “Steve Jobs spent a year with his cancer of the pancreas trusting homeopathic remedies, and by the time he got to the surgeons it was all over.” It is worth noting the veracity of this claim by Professor Edzard Ernst about Mr Jobs treating his cancer with homeopathy has left some struggling to find evidence for it, while others have claimed that for nine months after his diagnosis, Mr Jobs spurned what could have been life-saving surgery in favour of not homeopathy but a vegan diet and herbal remedies.

The “lesser universities” that have aroused the ire of FSM include the Australian Catholic University, Charles Sturt University, Central Queensland University, Edith Cowan University, Macquarie University, Monash University, Murdoch University, RMIT University, Southern Cross University, Swinburne University, the University of Ballarat, the University of New England, the University of Newcastle, the University of Queensland, the University of Technology Sydney, the University of Western Sydney, and the University of Wollongong. To buttress its case, FSM has gathered a list of offending courses, which includes Chinese Medicine, Wellness studies, Applied Eastern Anatomy, Clinical Science with options to study osteopathy and naturopathy, Mind/Body Medicine, and many others.

“It should be a policy that all universities, higher education institutions, should not be involved in in this woolly teaching,” Professor Dwyer said, adding that “I suspect that these are well attended, popular, money-earning courses for cash-strapped universities.”

The claims of FSM, however, ignore the evidence about CAM in higher education, said Dr Wardle, a NHMRC Research Fellow at the University of Queensland’s School of Population Health and co-director of the Network of Researchers in Public Health and Complementary and Alternative Medicine (NORPHCAM), an international group promoting clinical research in CAM.

“They’re actually not that interested in evidence, because the overwhelming evidence is that putting CAM into universities has increased the standards, decreased the fringe element, and improved public safety, so it definitely smacks of dogmatism,” said Dr Wardle, who is a naturopath.

“They love to say that there’s no such thing as complementary medicine and conventional medicine, there’s just evidence-based and non-evidence-based, but, for example, St John’s Wort for over a decade now has been shown to be equally as effective as any pharmaceutical indication for mild to moderate depression, yet there’s still a large group of doctors who refuse to integrate it simply because it’s a herbal medicine,” Dr Wardle said.

The world of CAM is not a “homogenous entity”, said Dr Wardle. “There is a lot of crap, but there’s good stuff, and treating it like it’s all the same thing is very, very fraught. Taking it out of universities runs a real risk of the fringe element getting a stronger voice in the profession.”

“There are studies from Canada, Australia, and Britain that show that CAM practitioners are less anti-vaccination when they’re university trained, and they refer more to conventional [medical] providers when things get serious if they’re university trained.”

“If you look at chiropractic courses [in universities], most of it is human physiology. Chiropractic is certainly not the dominant part of the course. If you look at naturopathy, they do learn herbal medicine and nutrition but they also learn basic health science: they learn the common language of health practice – they learn what a physio or a medical doctor or a nurse would learn. Putting it into the universities diminishes the fringe element,” Dr Wardle said. “If they [FSM] are really worried about public safety they should be not trying to exclude and ostracise them from the university sector.”

He questioned how representative FSM’s roll call of doctors really is, saying that he has just completed a survey of every rural GP in NSW and qualitative interviews with about 30. “About a third wouldn’t have anything to do with complementary medicine providers, another third were very open to it – maybe too open – and the other third if they knew a practitioner who got results they’d send people on.”

About 70 per cent of Australians use CAM and it thus makes sense for research and training to be carried out within the regulation and scientific rigour of the universities, Dr Wardle said.

Comments welcome below.

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

So, the NHMRC has found homeopathy doesn’t work. Now how do we get the message across?

By Ian Musgrave

The NHMRC has released its final statement on homeopathy. To no ones great surprise, the report concluded that there was no evidence that homeopathy was effective in treating any of 63 separate medical conditions.

I have already dealt with aspects of the interim report, and articles in The Conversation have already dealt with the report in general (see here and here), so I would like to look at it from a different angle; how do we effectively communicate the science behind the report?

Sure, the report is on the web, and has been mentioned in a variety of media and radio programs, but is this going to be effective? The need to effectively communicate these findings is highlighted by two separate occurrences, the recent debate over vaccination in the light of measles outbreaks overseas, and the recent CSIRO report that up to 40% of Australians are “disengaged” or actively distrust science.

After all, the target audience for this information is not the people who have been following the evidence, and are well aware that homeopathy is ineffective. To some degree the people who want to treat mild or self limiting conditions, for example insomnia, and who think that homeopathy is some form of herbal medicine are also not the target audience.

What we are worried about most is those people with serious conditions who abandon standard therapy for ineffective homeopathy (for example, trying to treat diabetes with homeopathic dilutions of uranium salts). We accept that adults should be able to choose (or reject) their therapies. But we also expect that people choose or reject therapies based on the best available evidence. What happens when people reject that evidence?

A recent paper looked at various ways to communicate with parents to increase vaccination rates. They found that parents accepted that the MMR vaccine did not cause significant side effects after the various communication strategies, but were not inclined to get their children vaccinated. One subset of parents, those who had the least favourable views on vaccination at the beginning of the study, were now LESS likely to vaccinate their children.

This is consistent with other studies (see also here) showing that when people with deeply entrenched beliefs are confronted with facts that disprove those beliefs, paradoxically they become firmer in their beliefs.

So how do we effectively communicate the science in the report? The NHMRC site has meticulous information on what they did, summaries and a FAQ, but we have to get people to read them. Most news articles and radio shows do not provide the information to find the report.

From a science communication point of view, most of the information on the NHMRC site is too technical for the general public. As an example of a good way to convey science around a contentious issue, the Australian Academy of Sciences has a great web accessible document that simply and clearly explains the science behind vaccines.

However, if you google “Vaccine Information Australia” you will see 4 of the top 10 results are vaccine denialist sites (and 3 of the top 5), and the AAS report is nowhere to be found.

As well as finding information in a format accessible to the general public, we need to consider that those most at risk of ignoring conventional medicine for homeopathy are also very likely to be in that 20% that the CSIRO found to be disengaged from or distrustful of science. As well, peoples perception of health and their health philosophy can make this a very emotionally charged issue.

We need to carefully consider how to approach this audience. In the light of the pediatrics paper, referenced above, where factual information led people to be less likely to vaccinate, merely giving people the facts is unlikely to be enough.

However, there are a variety of approaches that can be tried. Most of these have been developed in relation to politics or global warming, but the processes that are involved are similar.

In view of how homeopathy may be deeply linked with peoples world views, and showing homeopathy is no more than placebo may leave a gap in peoples beliefs (accounting for their reluctance to accept the facts), an approach such as replacing the gap with an alternative narrative may be the best approach.

Whatever the approach we use, the publication of the NHMRC report on homeopathy is the beginning of a long process of engagement, not the end of the matter.

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

Time to stop abusing the NHMRC for ideological purposes

By Michael Vagg, Barwon Health

The release today of the long-awaited NHMRC Statement and Advice on Homeopathy is just the latest in a series of pointless and ideologically motivated exercises that this peak scientific body has been tasked to undertake.

We have seen this group of professional scientists sent on wild goose chases after Wind Turbine Syndrome, water fluoridation and now homeopathy on behalf of a government that clearly wants science to be done to order for its political agenda. At a time when they are holding valuable, productive and world-class research infrastructure hostage to their unpopular higher education legislation, it is simply impossible to believe that the federal government takes science seriously at all.

Thankfully, the scientists continue to do their job well even when sent on a fool’s errand. The report on homeopathy is a model of science-based enquiry. It really should put to bed the case for supporting this entirely fantastical enterprise with science or higher education dollars. The analysis of the literature was comprehensive, covering some 1800 articles published. The majority of these were of such poor quality that only a couple of hundred even met the most basic criteria for further analysis. The consensus of these acceptable studies was that there was nothing to see here, and science should move on.

If some good is to come out of such a whimsical use of public funds, it should lead to the removal of public subsidies for private health insurance to cover homeopathy services. It should be wielded mercilessly in support of a crackdown by TGA and ACCC on the spivs and hucksters who sell complete moonshine to vulnerable patients. After all, as the Prime Minister reminded us yesterday in another context,

“ what we can’t do is endlessly subsidise lifestyle choices”

This Statement of Advice on homeopathy is reported to have cost around $800,000 to produce, and followed a similar document having been produced in the UK which arrived at the same conclusion just a couple of years earlier. I’m sure a few of Australia’s newly unemployed research scientists could have put that money to good use. The fluoridation and wind turbine fiascos add insult to injury by wasting precious science dollars on fatuous ideological stunts. One wonders whether NHMRC reports on the health effects of “superfoods” or dangers of immunisation will be next. Perhaps Senator McFarlane should just change his job title to Minister for Industry and Junk Science.

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

NHMRC Statement on Homeopathy

The National Health and Medical Research Council today released a statement concluding that there is no good quality evidence to support the claim that homeopathy is effective in treating health conditions.

Its release follows a thorough review of the evidence, conducted as part of NHMRC’s responsibility to provide advice and support informed health care decisions by the Australian community. This is the final outcome from the draft information paper the NHMRC released last year.

The conclusion is based on the findings of a rigorous assessment of more than 1800 papers. Of these, 225 studies met the criteria to be included in NHMRC’s examination of the effectiveness of homeopathy.

The review found no good quality, well-designed studies with enough participants to support the idea that homeopathy works better than a placebo, or causes health improvements equal to those of another treatment.

Further information is available here.

A $2.5m investment in wind farms and health won’t solve anything

By Simon Chapman, University of Sydney

The out-going head of the National Health and Medical Research Council (NHMRC) Warwick Anderson confirmed in Senate Estimates recently that calls for research proposals for up to a total of A$2.5 million over five years will soon be made to investigate questions about wind farms and health.

Under questioning from Greens Senator Richard Di Natale, Anderson told the committee A$2.5m was a paltry fraction of the agency’s total research budget, which in 2014 stood at A$802.42m. So A$2.5m is the equivalent of less than 0.06% of a projected five-year research budget on today’s allocations.

But researchers’ success obtaining grants has never been lower in Australia, with many strong grants falling below the cut-off score, which is ultimately budget determined. In 2014, researchers submitted 3,700 applications for project grants, with only one in 6.7 of these (14.9%) being funded. In the health services research field, 91.8% if applications were not funded.

Anderson has been emphatic that research standards will not be compromised in all this, and that only high-quality applications from suitably experienced researchers will be funded. It is not clear yet whether only one or more applications will be funded, if indeed any are.

The main debate in this area is between those who are adamant that wind turbines emit sounds and vibrations that upset and harm some of those exposed, and those who argue that the available evidence points strongly to health problems and complaints being psychogenic.

Nocebo phenomena – the idea that fear about wind turbines will cause some people to get symptoms – seem to be at the heart of both complaints and claims of illness.

I have documented an Old Testament-length list of 244 different symptoms and diseases alleged by wind farm opponents to be caused by the pestilence of wind farm exposure. The most bizarre of these include herpes, haemorrhoids, lung skin cancer and disoriented echidnas.

Study limitations

In even the best of studies, it will be impossible to separate out nocebo effects from putative direct effects. Here’s why. Ideally, researchers could select a location where a wind farm was being planned and conduct symptom- and illness-prevalence studies well before the wind farm was constructed and operational.

They would then repeat those measures at different times after the turbines began, analysing the influence of variables such as noise levels, economic benefit, pre-existing levels of antipathy to wind farms and “negatively oriented personality”. They could also request the production of medical records to see whether reported health problems long preceded the commencement of the turbines.

But this sort of research design will always be corrupted by wind farm opponents who, at the first hint of any wind farm development, move into a local area with the express purpose of alarming and frightening as many local residents as possible about what’s down the track.

No wind farm developer could ever commence construction without a long and open period of community consultation. These trigger the alarmists to turn on their best efforts to worry residents sick. This nocebo-priming case study I published recently describes in detail how they operate.

Residents fully sworn against wind farms are highly biased and can game such studies where self-reports of symptoms are central.

Lessons from Canada

Canada has already conducted the sort of study that might be proposed in Australia. In response to agitation from anti-wind groups, starting in 2012, it undertook the largest study of wind turbines and health ever attempted.

The study involved 1,235 houses in Ontario and Prince Edward Island, where randomly selected residents of all houses within 600m of 399 turbines on 18 wind farms were compared with those living 600m to 10km away.

In October 2014, Health Canada published the top-line results from the $CAN2.2 million study of the very sort that the NHMRC might well be asked to replicate.

It found the following were not associated with wind turbine noise:

• self-reported sleep (such as general disturbance, use of sleep medication, diagnosed sleep disorders)
• self-reported illnesses (such as dizziness, tinnitus, prevalence of frequent migraines and headaches) and chronic health conditions (such as heart disease, high blood pressure and diabetes)
• self-reported perceived stress and quality of life.

It did find that “annoyance” was related to wind turbine noise, with 16.5% of houses in Ontario and 6.3% on Prince Edward Island being annoyed.

Ontario is the epicentre of Canadian anti-wind farm activism, while Price Edward Island has seen little of this. So this major difference in the prevalence of annoyance lends support to the idea that wind farm annoyance is a “communicated disease” spread by anti-wind farm agitators.

The Canadian study also found that:

annoyance was significantly lower among the 110 participants who received personal benefit, which could include rent, payments or other indirect benefits of having wind turbines in the area e.g., community improvements. However, there were other factors that were found to be more strongly associated with annoyance, such as the visual appearance, concern for physical safety due to the presence of wind turbines and reporting to be sensitive to noise in general.

These findings are consistent with conclusions reached in what is now 24 reviews of the evidence.

Predictably, anti-wind farm groups in Canada rejected the Canadian study’s conclusions. It seems obvious that the only reports that such groups will ever accept are those which confirm their agenda. This is not a debate which will ever be resolved by research.

Political interests

Disturbingly, the NHMRC has allowed itself to be influenced by what reported internal email described as “the macro policy environment” – bureaucratic code for sensitivity to political interests.

Instead, Warwick Anderson and the Council should have stated clearly and emphatically to the parliament and the public that any researcher wanting to investigate wind farms and health was at perfect liberty to submit such a proposal to compete with all those being submitted by researchers considering any other topic. Such proposals would stand or fall on their competitiveness as determined by peer review.

There is no dedicated research funding being set aside by the NHMRC to further investigate the known massive risks to human health from fossil fuel extraction and burning. And it would be unimaginable for the NHMRC to quarantine money for any other non-disease like wifi sensitivity, smart electricity meter dangers or “fan death”. But this is what it has done here.

The money allocated is not much. But the real damage will be that in having this issue thus elevated to privileged research status, its political apostles will be greatly encouraged.

Editor’s note: please ensure your comments are courteous and on-topic.

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

We need new antibiotics to beat superbugs, but why are they so hard to find?

By Matthew Cooper, The University of Queensland

We’ve heard a lot lately about superbugs – bacteria that are resistant to current antibiotics. But as the threat of superbugs continues to rise, the number of new treatments available has flatlined. This has placed us dangerously close to the edge of a return to the pre-antibiotic era, when even simple infections caused death.

We’ve developed antibiotics in the past, so why it is now so difficult to discover and develop new antibiotics? To find out, let’s look back to the “golden age” of antibiotic discovery from the 1940 to 1970s.

How we found antibiotics in the past

The majority of antibiotics we use at home or in hospitals today have their origins in natural products.

The penicillins, cephalosporins, aminoglycosides, rifamycins, tetracyclines and glycopeptide-based antibiotics all came from bacteria or fungi. They were made by nature in response to selective evolutionary pressure over eons of “chemical warfare”, in which microorganisms battled to survive by killing off their competitors with antibiotics.

In the past, the toolkit to develop new antibiotics was simple.
Matej Kastelic/Flickr

Of course, they also co-evolved resistance mechanisms to avoid being killed by their own compounds, so antibiotic resistance is equally ancient. Scientists have found antibiotic resistance genes in bacteria isolated from 30,000-year-old permafrost, long before antibiotics were discovered and used by humans.

Most antibiotics found during the “golden age” were from micro-organisms themselves, isolated from soil or plants and then cultured in the laboratory. They were easily screened on agar culture plates or liquid culture broths to see if they could kill pathogenic bugs.

The toolkit required was pretty simple: some dirt, a culture flask to grow the antibiotic-producing bacteria or fungi, a column to separate and isolate the potential new antibiotic, and a culture plate and incubator to test if the compound could kill a disease-causing pathogenic bacteria.

Chemists were then able to “tweak” these new structures to extend their activity against different bacteria and improve their ability to treat infection in the clinic. Most of the antibiotics we have are derived from just one soil-dwelling bacterial order – the Actinomycetales.

Most antibiotics we use were derived from soil-dwelling bacteria.
whitaker/Shutterstock

The problem is that by using this tried and trusted method over and over again, we have found all of the low-hanging fruit antibiotics. So scientists have been forced to look further afield, turning to coral reefs, deep oceans and cave-dwelling bacteria to search for new promising molecules.

Key challenges

Philosopher Sun Tzu said “the supreme art of war is to subdue the enemy without fighting”. We are now in a protracted war against superbugs, as we have overplayed a key weapon against disease. Our unfortunate misuse and abuse of antibiotics means that bacteria have developed new ways to inactivate the drugs, to stop them getting to their targets within the bacteria cells, and to pump them back out of the cell when they do get in.

The cost and time required to bring new drugs to market are staggering. Estimates for the time to bring a new antibiotic through the preclinical, clinical and regulatory approval process are in the order of 13 to 15 years and around US$1.2 billion. If the costs of failures are factored in, it is closer to US$2.5 billion.

Because we expect to pay $20 or at most $200 for a course of antibiotics (compared to more than $20,000 for many cancer treatments), and because we only take antibiotics for a week or two, almost all of the companies that were active in antibiotic discovery have left the field over the last 20 years.

What are scientists doing?

It’s not all doom and gloom. Scientists have developed many innovative approaches to the search for new antibiotics, such as one recently reported in Nature, in which bacteria from soil are sealed into 10,000 separate miniature culture cells in a chip device, then buried in the soil they came from again to grow in their natural environment. The chip device is then dug up, and each cell screened for compounds that can kill pathogenic bacteria.

Developing new antibiotics is a long and expensive process.
Jenni Konrad/Flickr, CC BY-NC

This type of approach led to the discovery of one of the very few new candidate antibiotics in the last 30 years, teixobactin.

This type of innovation illustrates an important maxim: with good people, the right motivation, perseverance, and sufficient funding we can start to fix some of problems we face in this area.

What are governments doing?

Fortunately, governments around the world have started to respond.

British Prime Minister David Cameron and Chief Medical Officer Dame Sally Davis have been consistent vocal supporters of a cross-government strategy and action plan against superbugs. In fact, Dame Davies recognised that the threat from infections resistant to frontline antibiotics was so serious that she called for the issue to be added to the UK government’s national risk register of civil emergencies, alongside pandemic influenza and terrorism.

The European Union has stepped up with the Innovative Medicines Initiative (IMI), Europe’s largest public-private initiative aiming to speed up the development of better and safer medicines for patients. They have pledged more than €680 million (A$985 million) to fund drug-discovery platforms for antibiotics; new treatments for cystic fibrosis; hospital-acquired pneumonia and urinary tract infections; understanding how drugs get into, and then stay inside bacteria; and new ways of designing and implementing efficient clinical trials for novel antibiotics.

Scientists have been forced to look to coral reefs, deep oceans and cave-dwelling bacteria to search for promising new molecules.
©UCAR/Flickr, CC BY-NC

In the United States, the National Institutes of Health (NIH) invest more than US$5 billion (17% of total funds) into infectious diseases research, making it second only to cancer research at US$5.4 billion (18%). In a further show of support, US President Barack Obama also announced an Executive Order commanding a dozen government agencies to action a comprehensive action plan against superbugs.

So how are we doing in Australia? Infectious disease research for new antibiotics and diagnostic methods to identify superbugs is not yet an Australian national health priority area. In 2014, the Australian government, through the National Health and Medical Research Council, invested A$13.4 million into antibiotic development and resistance research, less than half of which was directed to discovery of new compounds. This equates to around 2% of the 2014 research budget.

We need better stewardship of existing antibiotics, better diagnostic methods and new antibiotics that we can take better care of this time around.

Unfortunately, we are dragging our feet in dealing with the superbug threat. This year, after more than 20 years of reviews and white papers, the Australian ministers for health and agriculture will be presented with comprehensive recommendations from leading clinicians, health-care workers, scientists, and policymakers about how we can work together to finally overcome the challenges of combating bacterial infections.

Yes, we’ve heard a lot lately about superbugs.

Now it’s time to act.

This article was originally published on The Conversation. (Reblogged with permission). Read the original article.