Repost: Nothing in Medicine Makes Sense in the Light of Homeopathy

Note: Due to an upcoming job change, and a number of deadlines before then, I don't have time to do any blogging at the moment. Instead I will try to re-post some of my better posts from the past. The original post can be found here

I am not the first person to state this, but I think that it's important that we all keep up saying this: Testing of homeopathic medicine should end.

Why do I say this? Well, for a very simple reason: There is no evidence that homeopathy works. And what's more, the whole concept of homeopathy flies against everything we know about chemistry, physics, and physiology.

This blog post is triggered by a truly abysmal study where homeopathic medicine was compared to proper medicine used for treating moderate to severe depressions - there were numerous flaws in the study (which I plan to address in a later post), but the fundamental problem was that it was comparing medicine with remedies based on nonsense.

There is a famous essay by Theodosius Dobzhansky called "Nothing in Biology Makes Sense Except in the Light of Evolution", which goes on to explain how our knowledge of biology wouldn't make sense except if evolution is true. One could write a similar essay, called say "Nothing in Medicine Makes Sense in the Light of Homeopathy", in which one explains how all our knowledge of medicine and physiology doesn't make sense if homeopathy is true.

I don't think this can be stressed enough.

It's not just a matter of science not understanding homeopathy. If homeopathy was true, it would mean that the basic building blocks upon which our knowledge is built would be wrong.

Given we know that this is not the case, homeopathy must be wrong. No, that's too mild; homeopathy must be absolute nonsense.

The basic concepts of homeopathy are things like "like cures like", miasms, and and the concept of "memory" in water, all of which is nonsense.

"Like cures like" (or law of similars) is the idea that medicine should be based upon things which gives the same symptoms as the original disease. This was perhaps plausible back when Hahnemann first proposed it two hundred years ago, but we now know that there is no truth to this idea. Sometimes the medicine will be based upon substances which gives similar symptoms, but mostly it won't.

Miasms are an old concept, in which diseases are caused by pollution or bad air. This idea was replaced by the germ theory of diseases, and is not taken serious by anyone except for certain branches of alternative "medicine" such as homeopathy, where they have added their own twists to the concept, but still stay largely true to the old Medieval concept.

The "memory" of water (or sugar for that matter) is the explanation used to explain how homeopathic medicine can have any effect. Homeopathic remedies are based upon the concept of diluting, in which the remedies are diluted to a degree where none of the original molecules are left (see this rather poor Wikipedia article for the numbers).

Oh, and the homeopaths also claim that the more diluted a remedy is, the more potent it is. Yes, this is really what they claim. No, it doesn't make any sense.

So, all in all, we know that homeopathy doesn't work. So, why the hell are we continuing to test it against proper medicine?

There are a lot of alternative "medicines" which might work, even if the concepts they are based upon are nonsense (e.g. acupuncture), and it makes sense to test these (so far, the effect of acupuncture seems to be placebo), but this is most certainly not the case with homeopathy. There is no way in which that can work.

Homeopaths might claim otherwise, but then it's up to them to explain how our basic understanding of chemistry, physics, physiology, and medicine is wrong in this matter, and yet works in every other case. In other words, it's up to the homeopaths to propose new theories in which homeopathy works, and which still supports our current state of knowledge, and until then, they should be ignored.

Not shunned, but ignored. Like we ignore perpetual motion machine builders, flat-earthers, and other weirdos.

Conventional medicine is not perfect, and our knowledge is expanding all the time, but theories like the germ theory of diseases are well established through science. We understand the mechanisms at play, and this knowledge enables us to fight diseases more efficiently. Much like our understanding of vira has helped us fighting other diseases more efficiently.

Why does claims of memory in water and strength through dilution bring to the table? In what ways are they expanding our knowledge? What diseases are we able to cure because of them? Nothing, none, and none are the answers. So stop bringing them to the table. Instead focus on the many valid ideas, which don't fly in the face of all the collective knowledge of the sciences.

Woos like to bring up Nobel Laureates Barry Marshall and Robin Warren, and their discovery that ulcers were caused by the bacterium Helicobacter pylori as an example of how outsiders can turn conventional knowledge on its head.

This is of course pure wishful thinking from their side. Marshall and Warren were very much part of the established scientific community, and while their proposal was received skeptically at first, it was not dismissed out of hand for some very simple reasons:

• It was built upon evidence.


• The mechanisms etc. all worked within conventional science and the mechanisms known at the time.


• There seemed to be some problems with the prevalent hypothesis at the time.

In other words, not only did they work within the established science, they actually addressed some known issues and presented evidence for their claims.

Yes, it took some time (and a very drastic demonstration) to convince people, but the scientific and medical community was very willing to be convinced, and as soon as there were sufficient evidence, the new explanation was universally accepted in quite a short time.

This is how it is done.

So, in what way has proponents of homeopathy done any of this?

The truth is that most people with a basic understanding of science understands that homeopathy is nonsense of the worst order, yet money is still spent on testing this nonsense, demonstrating again and again that it doesn't work. Why? We know that it doesn't work, since we understand the fundamental flaws in the premises behind homeopathy, and we know that homeopathic remedies are nothing but water, alcohol, or sugar (depending on whether they are liquid or in pill form), so they cannot work any better than placebo - they ARE placebo.

Let's put an end to this.

All it does is to lend credibility to homeopathy in the eyes of observers who don't know any better. They think that since homeopathic remedies are continuously being tested, there must be something to them. Why do we let this misconception continue? Science wins nothing from these sham studies, and it only lends cranks an aura of respectability. Stop it.

Yes, I am very passionate about this - we are allowing a lie to continue perpetually. That's wrong. Homeopathy has been around for 200 years, providing no value to society as a whole, and generally decreasing the general level of health, and it's time to stand up and say so.

It goes without saying that I have only contempt for hospitals and doctors who provide homeopathic remedies to their patients. Homeopathic practitioners are usually acting in good faith, believing in their nonsense, but doctors and nurses should know better - they have an education behind them, which provides them with the knowledge necessary to understand what nonsense homeopathy is.

Nothing in Medicine Makes Sense in the Light of Homeopathy

I am not the first person to state this, but I think that it's important that we all keep up saying this: Testing of homeopathic medicine should end.

Why do I say this? Well, for a very simple reason: There is no evidence that homeopathy works. And what's more, the whole concept of homeopathy flies against everything we know about chemistry, physics, and physiology.

This blog post is triggered by a truly abysmal study where homeopathic medicine was compared to proper medicine used for treating moderate to severe depressions - there were numerous flaws in the study (which I plan to address in a later post), but the fundamental problem was that it was comparing medicine with remedies based on nonsense.

There is a famous essay by Theodosius Dobzhansky called "Nothing in Biology Makes Sense Except in the Light of Evolution", which goes on to explain how our knowledge of biology wouldn't make sense except if evolution is true. One could write a similar essay, called say "Nothing in Medicine Makes Sense in the Light of Homeopathy", in which one explains how all our knowledge of medicine and physiology doesn't make sense if homeopathy is true.

I don't think this can be stressed enough.

It's not just a matter of science not understanding homeopathy. If homeopathy was true, it would mean that the basic building blocks upon which our knowledge is built would be wrong.

Given we know that this is not the case, homeopathy must be wrong. No, that's too mild; homeopathy must be absolute nonsense.

The basic concepts of homeopathy are things like "like cures like", miasms, and and the concept of "memory" in water, all of which is nonsense.

"Like cures like" (or law of similars) is the idea that medicine should be based upon things which gives the same symptoms as the original disease. This was perhaps plausible back when Hahnemann first proposed it two hundred years ago, but we now know that there is no truth to this idea. Sometimes the medicine will be based upon substances which gives similar symptoms, but mostly it won't.

Miasms are an old concept, in which diseases are caused by pollution or bad air. This idea was replaced by the germ theory of diseases, and is not taken serious by anyone except for certain branches of alternative "medicine" such as homeopathy, where they have added their own twists to the concept, but still stay largely true to the old Medieval concept.

The "memory" of water (or sugar for that matter) is the explanation used to explain how homeopathic medicine can have any effect. Homeopathic remedies are based upon the concept of diluting, in which the remedies are diluted to a degree where none of the original molecules are left (see this rather poor Wikipedia article for the numbers).

Oh, and the homeopaths also claim that the more diluted a remedy is, the more potent it is. Yes, this is really what they claim. No, it doesn't make any sense.

So, all in all, we know that homeopathy doesn't work. So, why the hell are we continuing to test it against proper medicine?

There are a lot of alternative "medicines" which might work, even if the concepts they are based upon are nonsense (e.g. acupuncture), and it makes sense to test these (so far, the effect of acupuncture seems to be placebo), but this is most certainly not the case with homeopathy. There is no way in which that can work.

Homeopaths might claim otherwise, but then it's up to them to explain how our basic understanding of chemistry, physics, physiology, and medicine is wrong in this matter, and yet works in every other case. In other words, it's up to the homeopaths to propose new theories in which homeopathy works, and which still supports our current state of knowledge, and until then, they should be ignored.

Not shunned, but ignored. Like we ignore perpetual motion machine builders, flat-earthers, and other weirdos.

Conventional medicine is not perfect, and our knowledge is expanding all the time, but theories like the germ theory of diseases are well established through science. We understand the mechanisms at play, and this knowledge enables us to fight diseases more efficiently. Much like our understanding of vira has helped us fighting other diseases more efficiently.

Why does claims of memory in water and strength through dilution bring to the table? In what ways are they expanding our knowledge? What diseases are we able to cure because of them? Nothing, none, and none are the answers. So stop bringing them to the table. Instead focus on the many valid ideas, which don't fly in the face of all the collective knowledge of the sciences.

Woos like to bring up Nobel Laureates Barry Marshall and Robin Warren, and their discovery that ulcers were caused by the bacterium Helicobacter pylori as an example of how outsiders can turn conventional knowledge on its head.

This is of course pure wishful thinking from their side. Marshall and Warren were very much part of the established scientific community, and while their proposal was received skeptically at first, it was not dismissed out of hand for some very simple reasons:

• It was built upon evidence.


• The mechanisms etc. all worked within conventional science and the mechanisms known at the time.


• There seemed to be some problems with the prevalent hypothesis at the time.

In other words, not only did they work within the established science, they actually addressed some known issues and presented evidence for their claims.

Yes, it took some time (and a very drastic demonstration) to convince people, but the scientific and medical community was very willing to be convinced, and as soon as there were sufficient evidence, the new explanation was universally accepted in quite a short time.

This is how it is done.

So, in what way has proponents of homeopathy done any of this?

The truth is that most people with a basic understanding of science understands that homeopathy is nonsense of the worst order, yet money is still spent on testing this nonsense, demonstrating again and again that it doesn't work. Why? We know that it doesn't work, since we understand the fundamental flaws in the premises behind homeopathy, and we know that homeopathic remedies are nothing but water, alcohol, or sugar (depending on whether they are liquid or in pill form), so they cannot work any better than placebo - they ARE placebo.

Let's put an end to this.

All it does is to lend credibility to homeopathy in the eyes of observers who don't know any better. They think that since homeopathic remedies are continuously being tested, there must be something to them. Why do we let this misconception continue? Science wins nothing from these sham studies, and it only lends cranks an aura of respectability. Stop it.

Yes, I am very passionate about this - we are allowing a lie to continue perpetually. That's wrong. Homeopathy has been around for 200 years, providing no value to society as a whole, and generally decreasing the general level of health, and it's time to stand up and say so.

It goes without saying that I have only contempt for hospitals and doctors who provide homeopathic remedies to their patients. Homeopathic practitioners are usually acting in good faith, believing in their nonsense, but doctors and nurses should know better - they have an education behind them, which provides them with the knowledge necessary to understand what nonsense homeopathy is.

Chimpanzees get AIDS too

This is really more the area of Tara or ERV but I still thought I'd comment on this piece of news.

African primates can be infected with over 40 different simian immunodeficiency viruses (SIVs). These diseases are related to two diseases which infects our particular species of primates, Homo sapiens, human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2) - indeed the two types of HIV are the result of SIVs crossing the species barrier.

HIV is considered an epidemic with more than 30 million people suffering from it worldwide (source - .pdf). As people hopefully know, HIV 1 and 2 will, if not treated by medicine, result in acquired immune deficiency syndrome (AIDS), which is fatal. 2 million people died from AIDS in 2007.

HIV and AIDS is one of the top prioritized areas of medical studies, and both the evolution of HIV from SIV and the connection between HIV and AIDS are well understood. This doesn't, however, keep some people from either claiming that HIV/AIDS is man-made, or that AIDS doesn't exist.

One of the arguments used by both groups is that SIV doesn't lead to AIDS in primates - the one group to argue that HIV couldn't have evolved from SIV, the other to argue that AIDS is not real.

Neither group makes sense. The lack of development of AIDS in SIV carrying primates is by no means evidence of there being no SIV-HIV connection, nor evidence of there being no HIV-AIDS connection.

Still, this matters even less now. Researchers have found out that some primates can get AIDS.

Nature has a new paper by Beatrice Hahn et al.

Increased mortality and AIDS-like immunopathology in wild chimpanzees infected with SIVcpz (link takes you to the abstract, the paper is behind a paywall)

African primates are naturally infected with over 40 different simian immunodeficiency viruses (SIVs), two of which have crossed the species barrier and generated human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2)1, 2. Unlike the human viruses, however, SIVs do not generally cause acquired immunodeficiency syndrome (AIDS) in their natural hosts3. Here we show that SIVcpz, the immediate precursor of HIV-1, is pathogenic in free-ranging chimpanzees. By following 94 members of two habituated chimpanzee communities in Gombe National Park, Tanzania, for over 9 years, we found a 10- to 16-fold higher age-corrected death hazard for SIVcpz-infected (n = 17) compared to uninfected (n = 77) chimpanzees. We also found that SIVcpz-infected females were less likely to give birth and had a higher infant mortality rate than uninfected females. Immunohistochemistry and in situ hybridization of post-mortem spleen and lymph node samples from three infected and two uninfected chimpanzees revealed significant CD4+ T-cell depletion in all infected individuals, with evidence of high viral replication and extensive follicular dendritic cell virus trapping in one of them. One female, who died within 3 years of acquiring SIVcpz, had histopathological findings consistent with end-stage AIDS. These results indicate that SIVcpz, like HIV-1, is associated with progressive CD4+ T-cell loss, lymphatic tissue destruction and premature death. These findings challenge the prevailing view that all natural SIV infections are non-pathogenic and suggest that SIVcpz has a substantial negative impact on the health, reproduction and lifespan of chimpanzees in the wild.

In other words, there is a non-trivial health cost in being infected with SIVcpz.

This is not a trivial finding. As Nature makes clear in it's news release on the story (Wild chimpanzees get AIDS-like illness) this will impact future research.

The results suggest that it will not be possible to find the key to HIV immunity in the chimpanzee genome, as scientists had hoped. However, the study, published in Nature, sets the stage for researchers to gain insight into how HIV and SIV cause disease in their hosts by studying the responses of different primates to the viruses. Wild monkeys that have coexisted with SIV for a long time — such as sooty mangabeys and African green monkeys — seem to have evolved the ability to control SIV, and so do not become ill when exposed to the virus. The new paper, however, shows that chimpanzees — which, like humans, were exposed to SIV more recently — are sickened by the virus.

NY Times also writes about this study: Chimpanzees Do Die From Simian AIDS, Study Finds

Update: Carl Zimmer has written a great blog post about this.

The poor doctors want to be able to proselytize

Via several of my facebook friend, I read this BBC article

Doctors want right to talk faith

Doctors are demanding that NHS staff be given a right to discuss spiritual issues with patients as well as being allowed to offer to pray for them.

Medics will tell the British Medical Association conference this week that staff should not be disciplined as long as they handle the issue sensitively.

The people in question might call it "talk faith", I call it proselytizing, and I find it entirely wrong for any medical personnel to be involved in that - no matter the faith in question (I would also find it wrong for an atheist to try to deconvert people in hospitals).

There are several reasons for why it's wrong, but the one most people should be able to understand, is the fact that the patients are a captured audience, who can't just get up and leave. They should also feel comfortable with the medical personnel they come into contact with, and if said personnel tried to proselytize in any way or form, it would make a great number of the patients feel uncomfortable.

I really can't see why this should be so hard to understand.

And to make it even worse: as the article makes clear, there are even dedicated personnel to cater to peoples' religious needs.

However, the Department of Health said it was the responsibility of the NHS Chaplaincy Service to meet the spiritual needs of patients.

A spokeswoman said: "We are committed to the principle of ensuring that patients and staff in the NHS have access to the spiritual care that they want, whatever faith or belief system they follow.

"Although all staff should be sensitive to religious needs and preferences of patients, the delivery of spiritual care should be provided by the hospital chaplaincy service."

Still, some of the people interviewed in the article doesn't get it.

But Joyce Robins, co-director of Patient Concern said: "Most complaints from patients are about being on a conveyor belt of care. They don't rate with staff as real people.

"Offering to say a prayer is a warm and kind thought. Most patients will accept it as such. It is no more offensive than being offered a sleeping pill. You can say thanks but that sort of thing isn't my cup of tea.

As an atheist, I would kindly ask the doctor, nurse, or whatever to bugger off and never bother me again. I would also complain to the hospital, and ask them to ensure that said person had nothing to do with me in any way or form again. It's not only because I would find it offensive, which I would, but also because I would find it disturbing and profoundly unprofessional. I would, in other words, loose my trust in said person.

Still, my reaction would be mild compared to the reaction of e.g. a Muslim, Jew, or Hindu person, if a Christian person offered to say a prayer for them (and vice versa). To many of those people, it would be an insult of the greatest degree.

For a person like Joyce Robins to not understand this shows how sheltered from other cultures she has been.

It's really not a question about freedom of religion, but a question of being a professional. As someone employed as a medical personnel you are entitled to your religious beliefs, but you are not entitled to push them on other, while acting in an official capacity. What you do outside your workplace, is your own business (with certain legal limits of course).

Why vaccinations matter

It's barely a week since Barack Obama was elected in the historical 2008 Presidential election, and there has been some rumors going around about which people he would pick for his administration. One of the names that has been mentioned, was Robert F. Kennedy, Jr. (RFK) as head of the U.S. Environmental Protection Agency (EPA).

RFK has a solid record on defending the environment, and some progressives where quite happy about this possibility. There was one group of people who were vehemently against this choice, however, the science bloggers (who are largely progressive). This might surprise people, but with a little background knowledge, it makes perfect sense.

Scientists, and science in general, have been among those most negatively affected by the Bush administrations, which were actively anti-science and anti-scientist. It would take too long to go into all of the ways this happened, but for more on this subject I recommend Chris Mooney's excellent book The Republican War on Science.

While not all scientists and science bloggers where overwhelmed by Obama, there was a clear sense that if Obama won, this would change. Politics would stop interfering in sound science, and scientists would not face political pressure to confirm with political stances. In other words, an Obama administration, would result in a, if not pro-science, then at least neutral attitude towards science from the politicians.

This is why the suggestion of RFK as head of the EPA dismayed many scientists and science bloggers. RFK as it happens, is not the sort of person that gives confidence of an pro-science atmosphere. As a matter of fact, RFK is considered not only ignorant of science, but actively against sound science by many of us.

Why do we feel this way? It all goes back to June 2005, where RFK wrote an article that appeared in both Rolling Stones and Salon.com. The article was titled "Deadly immunity" and was the shocking tale about how the scientific and medical community were covering up on how vaccinations causes autism. Or rather, how the component thimerosal, which degrades to ethylmercury, were the culprit of the rising number of autistic children.

This was indeed a shocking article, but not for the reasons RFK claimed. The shocking part of the article was the fact that anyone would publish it. Anyone spending more than five minutes on fact checking it, would have found numerous problems with it. The primary one being that there is absolutely no evidence of there being any kind of connection between vaccinations and autism. And it's not like there hadn't been any research into it at the time where RFK wrote the article. There had been large epistemological studies in several countries, including my own native country, Denmark, that couldn't find any causation between vaccinations and autism. While scientists and people in medicine, are cautionary in nature, there were an overwhelming consensus of rejecting any autism-vaccination link.

Another major problem with the article, is that RFK demonstrated rather impressively the difference between how scientists and lawyers debate. In science, it is regarded as a cardinal sin to leave out contrary evidence, to quote out of context (often referred to as "quote-mining"), and to pick just the data that suits your (called "cherry picking"). Among lawyers, this is not only acceptable, but actually good practice - they are trying to win a case after all. One of the things RFK did in the article, was to quote parts of the transcript from the Simpsonwood conference, where a possible autism-vaccination link was debated. The quotes RFK presented gave a clear indication of a conspiracy to hush up a autism-vaccination link, demonstrating to the readers that the scientists had something to hide. The problem was of course, that the quotes were taken out of context, as a skeptic blogger, Skeptico, demonstrated by finding the quotes in the transcript, and including the context (Robert F. Kennedy Junior’s completely dishonest thimerosal article). So, not only were the transcript of the conspiracy easily available on the internet, but a quick browse through it, would demonstrate that there were actually no conspiracy at all.

Still, RFK's articles did their job, making the readers believe that there were something dangerous about giving their kids vaccinations, thus increasing the number of people who didn't give their kids any.

That's unforgivable.

It's without any type of hyperbole that I would claim that vaccinations are among the most important contributors to the increased standard of living in the last 100 years. It's practically impossible to overstate the impact the availability of cheap, easily obtainable vaccinations have had on our societies today.

20 years ago, when I had English in my primary school, I had a teacher who could not use one of her arms, due to the polio she had as a child. Polio used to cripple, and even kill, children every year until the vaccinations made by Stalk in 1952 and Sabin in 1962 made it possible to vaccinate against it. Now polio is extremely rare in the Western World.

Smallpox used to be a major thread all over the world. According to the WHO fact sheet on smallpox: "As late as the 18th century, smallpox killed every 10th child born in Sweden and France. During the same century, every 7th child born in Russia died from smallpox." Now Smallpox is considered eradicated, due to a worldwide vaccination campaign.

Less serious diseases like Rubella, Mumps and Measles, are covered by the MMR vaccinations given in childhood. Rubella can cause brain damage to the child, if caught by a pregnant woman. Rubella and Mumps can cause hospitalization, but are rarely fatal. Measles, on the other hand, causes deaths. According to the WHO fact sheet on Measles:

# Measles remains a leading cause of death among young children, despite the availability of a safe and effective vaccine for the past 40 years.
# In 2006, it was estimated that there were 242 000 measles deaths globally: this translates to about 663 deaths every day or 27 deaths every hour.

In other words, Measles are not just a minor issue, and people who allow their children to get effected with Measles, are risking their lives. Even if the child survives, there is a real risk of brain damage from complications due to Measles.

And then there is the problem of herd immunity.

Some people who are vaccinated, are not actually immunized. This means that if there is an outbreak of the disease, they are at risk catching it. Others are not able to get the vaccination for medical reasons (problems with their immune system could be one reason). Again they are at risk during an outbreak. These people are dependent on "herd immunity", where enough people are immunized to keep the diseases from spreading. Due to the increased number of children not getting vaccinated, these people are at increased risk of getting the diseases. So, it's not just the health of their children the parents are risking, it's also the health of other peoples' children.

As it stands right now, it doesn't look like Robert F. Kennedy, Jr. is going to be appointed as head of the EPA, but the dark legacy of his fear mongering lives on. He has never retracted any of his statements in the article, and he is actively supporting the "Green Our Vaccines" campaign lead by Jenny McCarthy - another campaign aimed at getting people scared of vaccines. The war against science lives on, in another legacy. Let's hope it never gets officially sanctioned by the Obama administration.

HIV testing of pregnant women

While looking around over at PLoS One, I came across this study.

Rapid Testing May Not Improve Uptake of HIV Testing and Same Day Results in a Rural South African Community: A Cohort Study of 12,000 Women by Mkwanazi et al.

Personally, I found the title confusing, but what it tries to convey is the fact that the availability of rapid HIV testing has not led to more people wanting to get tested, contrary to what one might have believed.

Background

Rapid testing of pregnant women aims to increase uptake of HIV testing and results and thus optimize care. We report on the acceptability of HIV counselling and testing, and uptake of results, before and after the introduction of rapid testing in this area.

Methods and Principal Findings

HIV counsellors offered counselling and testing to women attending 8 antenatal clinics, prior to enrolment into a study examining infant feeding and postnatal HIV transmission. From August 2001 to April 2003, blood was sent for HIV ELISA testing in line with the Prevention of Mother-to-Child Transmission (PMTCT) programme in the district. From May 2003 to September 2004 women were offered a rapid HIV test as part of the PMTCT programme, but also continued to have ELISA testing for study purposes. Of 12,323 women counselled, 5,879 attended clinic prior to May 2003, and 6,444 after May 2003 when rapid testing was introduced; of whom 4,324 (74.6%) and 4,810 (74.6%) agreed to have an HIV test respectively. Of the 4,810 women who had a rapid HIV test, only 166 (3.4%) requested to receive their results on the same day as testing, the remainder opted to return for results at a later appointment. Women with secondary school education were less likely to agree to testing than those with no education (AOR 0.648, p<0.001), as were women aged 21–35 (AOR 0.762, p<0.001) and >35 years (AOR 0.756, p<0.01) compared to those >20 years.

Conclusions

Contrary to other reports, few women who had rapid tests accepted their HIV results the same day. Finding strategies to increase the proportion of pregnant women knowing their HIV results is critical so that appropriate care can be given.

The study is interesting for several reasons. Not only did it find that rapid test results are not helping getting more women to get tested, it also shows that young women (below 21 years old) are more likely to get tested, and that educated women are less likely to get tested. Also, in the time period observed, there has been a general downward trend in getting tested.

All of this makes it sound like that targeted promotion of HIV tests to educated women and/or women above 20 could be at least as efficient as ensuring rapid test results.

116th Tangled Bank

Welcome to the 116th edition of the Tangled Bank. As usually, we have a lot of good stuff for you all. Unlike some former hosts, I am not a very creative writer, and I'll spare you all from any attempts of making some kind of theme for this Tangled Bank. So, without any further ado, let's get to the posts.

Biology, botany, paleontology and evolution

Perhaps unsurprisingly, posts about these subjects are well represented (again) in this edition. The reason why I group them together, is that it can sometimes be hard to say whether a post is about botany or biology, or about biology or paleontology.

Over at the Evolving Mind, Andrew goes into the past with his post Not Chicken Fingers, Fish Fingers

GrrlScientist tells the story of one positive result from Hurricane Ike: Hurricane Ike Unearths Fossil Tooth in Paleontologist's Yard

Another post by GrrlScientist tells us about the newest research into how "individuals of a social species engag[ing] in frequent battles for limited reproductive opportunities" can have a negative impact on conservation efforts. Love, Sex and War in the Seychelles

At Pleiotropy, Bjørn Østman writes about the latest research into the evolution of DNA in Non-functional DNA conserved in evolution

Dr. Jeff Wells writes about Carbon-Eating Forests over at the Boreal Bird Blog

Perhaps a bit borderline, as it deals with politics, I still found DanH's post Does the IUCN take agricultural biodiversity seriously? relevant for this carnival.

At the FruitForum they write wild apple trees in An Apple at the Sea Side!, and at Agricultural Biodiversity Weblog, Jeremy writes about a landscape to marvel at.

Mike shares the good news Birds Make Peace With Turbines. Always good with some more peace in the world....

Again, political in nature, but again relevant to science and medicine: Obama, McCain on Our Ocean's Health by Kevin Zelnio at Deep Sea News

Eric Heupel not only shares with us the tale of the Nobel Jelly, but also goes into grasshoppers in Wilted Greens

neurobiotaxis writes about Cerebral assymetry in an evolutionary perspective

The founder of the Tangled Bank, PZ Myers, is apparently too modest to send any submissions, but I thought I'd include his post on the Fossil daisy-chain

Medicine

Over at Tunnel Under Snow, Noni Mausa used the opportunity of Mental Illness Awareness Week to bring our attention to our own behavior. With friends like this...

PalMD gives us a lesson in Cancer 101

Math and physics

It's not all just posts related to biology etc. There is also some posts about other types of science.

At Stochastic Scribbles, the meaning of the number 137 is explained to us.

Photos and art

This category deals with posts containing photos and art related to science.

GrrlScientist has a post up on the photos from the Scopes Trial: Original Photos from the 1925 Scopes Monkey Trial: John Thomas Scopes. Make sure to click through to the full flickr collection, which has been put up.

Over at Drawing the Motmot, Debby Cotter Kaspari shares some of her work with us. The Light in the Dark Forest and Plein Air Pen and Ink. As someone without any artistic talent, I'm always in awe of other peoples' works.

Odd bits

Posts that are hard to categorize, but which might still fit into the general theme of the Tangled Bank.

At Science Made Cool, Cambias goes a little into the problems with werewolf lore: Monster Mash(3)

At Submitted to a Candid World, they take a hard look at a certain brand of homeschooling: Conservapedia Tries Homeschooling; and, the Miseducation of America’s Youth

Food chemistry is also a form of science, so I found Brian's post over at The Off Season Recipe Blog well worthy of inclusion: Oh, must be pectin 'cause starch don't shake like that

Grrlscientist takes us for a visit to The Montlake Fill (UBNA) in Seattle.

I was asked to point people to a new science-related blog Vaviblog, and any blog that has guest posts from Ola T. Westengen, Coordinator of the Svalbard Global Seed Vault in Norway, cannot be completely uninteresting to the readers of this carnival.

This concludes the 116th edition of the Tangled Bank, I hope you enjoyed it. The next edition will be up on 29 October 2008 at Neural Gourmet

Evaluating medical studies

Currently, the ScienceBlogs Book Club is discussing Paul Offit's Autism's False Prophets (which I've just ordered). For those unaware of the subject of autism and autism research, the heated discussion going on in the comments sector will probably surprise you.

The heat is because the debate about autism, and the cause of autism, as it happens on the internet, is not about science, but about emotions, and in some cases, about profit. When I say profit, I'm not referring to the pharmaceutical businesses, that makes the vaccinations, that some people claim causes autism, but rather the people pushing dangerous "cures" at high prices to the parents of autistic children. Because, frankly speaking, vaccinations are very low on the profit scale when it comes to the pharmaceutical sector (Viagra and happy pills would be a much better business).

Of course, just because one side might profit from something being true, doesn't mean that it's not true. The makers of penicillin make a profit, yet penicillin has saved more lives than it's possible to count.

When I first heard about the possibility of an autism-vaccination link, from a blogger I respect, I thought it sounded somewhat feasible, since the cause of autism is not particularly well known. Also, the fact that vaccinations contained thimerosal, which is based on a type of mercury, seemed worrisome.

In other words, while I wasn't convinced of the link, I certainly was open to the idea.

However, I began to run into other bloggers, pointing out the problems with this hypothesis, and I began noticing a problematic pattern. There has been a lot of research into autism, and a lot of research into the possibility of an autism-vaccination link. A few studies pointed towards an autism-vaccination link, while the majority showed no link. As such, this might not tell us one way or another, since the minority studies might be the better studies. However, by any objective measure, this was certainly not the case, and what's more, it turned out that, while we don't know everything about the cause of autism, we do know some things, and what we know, invalidates the hypothesis of a link between autism and vaccinations.

So, how does one go about evaluating studies? Well, I obviously have some criteria I follow, but instead of going through them, I think it's much better to point to an excellent article on the very subject in the NY Times by Gina Kolata: Searching for Clarity: A Primer on Medical Studies (might require that you log in).

Kolata explains clearly what kind of things you have to look at when evaluating medical studies, and while the examples she refers to, all had the minority studies overturn the majority studies, it's much more common the other way around, as we can see in the studies about autism-vaccination links.

For more stuff about the proper way to evaluate and do medical studies, I recommend the group-blog Science-Based Medicine.

Lazy linking

Another round of interesting links, that I would like to share.

Via Book Balloon, I came across two interesting links.

Scientists recover complete dinosaur skeleton

Japanese and Mongolian scientists have successfully recovered the complete skeleton of a 70-million-year-old young dinosaur, a nature museum announced Thursday.

The scientists uncovered a Tarbosaurus—related to the giant carnivorous Tyrannosaurus—from a chunk of sandstone they dug up in August, 2006 in the Gobi Desert in Mongolia, said Takuji Yokoyama, a spokesman for the Hayashibara Museum of Natural Sciences, a co-organizer of the joint research project.

"We were so lucky to have found remains that turned out to be a complete set of all the important parts," he said.

After two years of careful preparatory work, scientists found that the fossilized skeleton only lacked neck bones and the tip of the tail.

Young dinosaur skeletons are hard to find in good condition because they often are destroyed by weather decay or because they were torn apart by predators. The latest find would be a major step toward discovering the growth and development of dinosaurs, Yokoyama said.

Silent spring

Deep in the radioactive bowels of the smashed Chernobyl reactor, a strange new lifeform is blooming.

The 92nd Skeptics' Circle is up over at the Lay Scientist. It's a new blog to me, but it's definitely not the last time I've visited it.

Over at Wired there is a quite interesting article, at least to me, about what open source projects do with money they receive.
What Do Small Open Source Projects Do With Money? Not Much.
I think it goes without saying that we hardly have these problems in the sort of projects I work in.

PalMD takes on the Bush administration's new theocratic urges in two posts Theocracy in action---HHS proposes to limit birth control and Conscientious objector or deserter?

An oldie, but good: How to Sell a Pseudoscience

Feministing has a good Weekly Feminist Reader

The Obama campaign has started a new website Fight the Smears

Why isn't it legalized for medical treatment?

ScienceDaily brings the news about how marijuana has been show to be effective against neuropathic pain.

Researchers at University of California Davis examined whether marijuana produces analgesia for patients with neuropathic pain. Thirty-eight patients were examined. They were given either high-dose (7%), low-dose (3.5%) or placebo cannabis.

The authors reported that identical levels of analgesia were produced at each cumulative dose level by both concentrations of the agent. As with opioids, cannabis does not rely on a relaxing or tranquilizing effect, but reduces the core component of nociception and the emotional aspect of the pain experience to an equal degree. There were undesirable consequences observed from cannabis smoking, such as feeing high or impaired, but they did not inhibit tolerability or cause anyone to withdraw from the study. In general, side effects and mood changes were inconsequential.

I am not a great fan of people smoking weed, and especially not of those who claims that it has no ill effect, or even worse, that it's not addictive. Have gone to school with kids who were hooked on the stuff (and I don't care if it was a mental or physical addiction, addiction is addiction), I don't have any romantic notions about it.

However, the same can be said of alcohol, which is legal to consume in most of the world.

So, why can't marijuana be legalized for medical use (or in general)? Yes, there are ill effects of it, but less so than there is of legal things like cigarettes and alcohol. And when we talk about people with the sort of pain treated in this experiment, I think the benefits clearly out weights the costs.

I can't seem to find the study in the current issue of >The Journal of Pain¹, but I'm sure it will show up within the next few days. It will appear under the title A Randomized, Placebo-Controlled, Crossover Trial of Cannibis Cigarettes in Neuropathic Pain by Barth Wilsey et al.

¹Am I the only one who thinks this sounds like the trade magazine for torturers?

High levels of lead found in Herbalife products

There is an institute called the Fraud Discovery Institute which has been investigating Herbalife for a number of issues.

In May they released a report on the findings of dangerously high lead levels in six common Herbalife products - it can be found here (.pdf) While earlier studies in to Herbalife products haven't focused on lead, they have found indications of serious dangers, when people took those products. This was reported in an article in Journal of Hepatology issue 47 (2007) page 521–526, which is also available from the Fraud Discovery Institute website (.pdf)

Herbalife reacted to the report about lead levels by stating that two independent labs had vindicated their products from these accusations. Not surprisingly, the Discovery Fraud Institute doesn't agree with this.

Now it seems like there is going to be further investigation into it.

I find Herbalife problematic for a number of reasons, not least because they are basically a pyramid scheme. However, this is much more serious accusations than anything I've previously heard, and I hope that there is some serious investigation into this.

Weakness in virus gives hope for cancer cure

ScienceDaily has the news.

Serious Weakness Found In Virus Responsible For Most Cervical Cancer

The virus responsible for most cases of cervical cancer has a serious weakness which may provide hope for new treatments for the disease.

Human Papillomavirus (HPV), a virus which causes several types of cancer but is particularly associated with cervical cancer, has developed clever ways of hiding in the body, but researchers at the University of Leeds have found that its ability to trick the body's first line of defence leaves it vulnerable to attack from a second defence system.

This sounds like a promising line, and hopefully the new knowledge can lead to a treatment for this virus, before it causes cancer.

Why medical experiments matter

A couple of days ago, Orac wrote a long post about animal testing - Bad scientific arguments in the service of "animal rights" activism.

Personally, I dislike furs and am against unnecessary animal testing ("unnecessary" of course being the hard-to-define keyword). Necessary testing, such as medical testing, on the other hand, I'm all for, and Orac gives many good arguments for why I should continue endorsing it.

One of the good examples that Orac mentions Dr. Judah Folkman, who did some critical cancer research on mice.

Folkman found a mouse tumor model that mimicked this behavior and in the early 1990s did a series of pioneering experiments. In a strain Lewis lung carcinoma cells of low metastatic potential (LLC-LM), when cells are injected into C57BL/6 mice and allowed to grow subcutaneously, if the tumor is left alone, mice develop only microscopic lung metastases. These metastases do not grow and kill the mouse. If, however, the primary cancer is removed, then many large lung metastases grow rapidly. The results of the experiment above strongly implied that the primary tumor is secreting something that suppresses the growth of microscopic metastases. After this, the Folkman group did what we like to call "brute force" science, collecting mouse urine and analyzing it for tumor suppressive activity until they were able to purify a single 38 kDa peptide, which they designated angiostatin. This involved analyzing literally gallons of mouse urine. (Who said science isn't glamorous?) Once Folkman's group had a bunch of angiostatin on hand, it peformed the following experiment. Two groups of mice were injected with LLC-LM and the tumors allowed to grow to a certain size, after which they were surgically removed. One group was treated with angiostatin, and the control group with saline. The result was that the control group developed massive lung metastases and died, while the group treated with angiostatin had microsocopic lung metastases that never grew beyond a ball of cells. Dr. Folkman then demonstrated that it was the inhibition of angiogenesis by the angiostatin that kept these tumors in check. Ultimately, he used a similar method to discover endostatin, and later he demonstrated that endostatin could induced tumor dormancy in mice. I trust that the reader can see how these seminal preclinical observations about angiogenesis would have been virtually impossible without animal models, given that angiogenesis requires the interaction between tumor cells, cells in blood vessels, and the surrounding tissue stroma to occur.

Of course, after this was done, Folkman could move on to testing on humans, but the animal testing was vital.

Just to put Orac's example into perspective, the very next day the NY Times, had an article about one of the humans involved in the tests - A Daring Treatment, a Little Girl’s Survival. The treatment is still being researched, and the data is so far anecdotal, but it seems promising. This means that it looks like Folman's experiments on mice will end up saving the lives of many humans, including the small girl mentioned in the NY Times article.

I'm sorry, but if I have to choose between humans and laboratory breed mice, I'll go for the humans.

New piece of medicine research

I came across this piece of interesting news: Some researchers have found out that it's possible to treat Staphylococcus aureus with an anti-cholesterol medication.

Staphylococcus aureus is a very hard bacterium for the immune system to combat, to a large degree because its color pigmentation protects it. The researchers found that the treatment with the anti-cholesterol medication blocks the pigmentation of the bacteria, leaving it open for attacks from the body's immune system.

The research has been pre-released in Science, and the abstract can be found here. Unfortunately, the actual paper is behind a pay-wall.

Much needed new blog in town

As most of my readers are probably aware, there is a great new group blog called Science Based Medicine.

It can be considered similar to blogs like The Panda's Thumb and RealClimate, both of which focuses on debunking pseudo- and anti-science related to a specific topic.

Science Based Medicine describes itself thus:

Science-Based Medicine is a new daily science blog dedicated to promoting the highest standards and traditions of science in medicine and health care. The mission of this blog is to scientifically examine medical and health topics of interest to the public. This includes reviewing newly published studies, examining dubious products and claims, providing much needed scientific balance to the often credulous health reporting, and exploring issues related to the regulation of scientific quality in medicine.

Another daily read is added to the long list.

The future of AIDS treatment

MSNBC has an article, Finding the way again after failed AIDS vaccine, about the future of HIV/AIDS treatment, after the recent failure of a new vaccine by Merck (not only didn't it help people, it seemed like the vaccination might make it easier for people to get infected by HIV).

The MSNBC article raises some good point, especially at the end, where Robert Bazell writes

But meanwhile we do know that treatment works well for those who are infected, and old-fashioned prevention efforts keep people from getting infected in the first place. Perhaps it is time to re-think the priorities.

I think Bazell is both right and wrong. Yes, we should up-prioritize research into treatments, and focus on proper sex-ed (which is most assuredly not abstinence-only sex-ed). On the other hand, it is also necessary to find a cure for HIV, and we shouldn't cut back on that. Instead, we could cut back on many other less urgent, or directly wasteful, things (think what kind of resources an end to the Iraq war would free).

Another thing we need to educate people on, is what causes HIV/AIDS, so AIDS-denialists are rejected as the idiots they are. Now, too much credence is made to their dangerous ideas by far too many people, including people in positions of power.

Better understanding of mammalian hearing

I had the impression that the hows and whys of hearing was pretty much known, at least when it came to mammals, but a new discovery shows that I was wrong about that.

ScienceDaily reports on it.

New Hearing Mechanism Discovered

MIT researchers have discovered a hearing mechanism that fundamentally changes the current understanding of inner ear function. This new mechanism could help explain the ear's remarkable ability to sense and discriminate sounds. Its discovery could eventually lead to improved systems for restoring hearing.

MIT Professor Dennis M. Freeman, working with graduate student Roozbeh Ghaffari and research scientist Alexander J. Aranyosi, found that the tectorial membrane, a gelatinous structure inside the cochlea of the ear, is much more important to hearing than previously thought. It can selectively pick up and transmit energy to different parts of the cochlea via a kind of wave that is different from that commonly associated with hearing.

The article explains in some detail how this discovery differentiates from our former knowledge.

It has been known for over half a century that inside the cochlea sound waves are translated into up-and-down waves that travel along a structure called the basilar membrane. But the team has now found that a different kind of wave, a traveling wave that moves from side to side, can also carry sound energy. This wave moves along the tectorial membrane, which is situated directly above the sensory hair cells that transmit sounds to the brain. This second wave mechanism is poised to play a crucial role in delivering sound signals to these hair cells.

In short, the ear can mechanically translate sounds into two different kinds of wave motion at once. These waves can interact to excite the hair cells and enhance their sensitivity, "which may help explain how we hear sounds as quiet as whispers," says Aranyosi. The interactions between these two wave mechanisms may be a key part of how we are able to hear with such fidelity - for example, knowing when a single instrument in an orchestra is out of tune.

It's always fascinating when scientists expand on our knowledge, especially so when it's on our knowledge of how the body functions.

The research has been published in Proceedings of the National Academy of Sciences (with the graduate student as the first-name author), and it's a featured article, so it's available for free.

Longitudinally propagating traveling waves of the mammalian tectorial membrane

This might revolutionize cancer treatment

One of the big issues with cancer treatment is finding the cancer in time to do something about it. At ScienceDaily there is some news which might help in this regard.

New Technology For Cancer Screening Listens For The Signs Of Cancer

Cancer-sensing devices built as cheaply and efficiently as wristwatches -- using many of the same operating principles -- could change the way clinicians detect, treat and monitor cancer in patients.

A device which can be mass-produced cheaply sounds like good news indeed. This would mean that it could be widely distributed to family doctors (presuming it's easy to use), and save people hospital visits for a diagnosis.

Researchers from the Georgia Institute of Technology have created an acoustic sensor that can report the presence of small amounts of mesothelin, a molecule associated with a number of cancers including mesothelioma, as they attach to the sensor's surface.

I am sure this will result in a number of false positives, but I'd rather have false positives, than diagnoses that come to late to do anything about it.

Of course, it's important to note that not all types of cancers would be possible to detect this way.

According to the researchers, the study is a proof of principle, demonstrating a technique that might work for the detection of nearly any biomarker -- a collective term for a molecular signal that denotes the presence of disease.

"It is one thing to be able to identify biomarkers for a disease, but it is another to be able to find them in blood quickly and easily at very low concentrations," said Anthony Dickherber, a graduate student in the School of Electrical and Computer Engineering at Georgia Tech. "We envision that, one day, doctors can use an array of our sensors as a sort of laboratory in their office, where they could use a quick blood sample to detect or monitor the signs of cancer."

I hope that the proof of principle can be reproduced, and that this device will become available as fast as possible. If they are right, I can't see any downside to the device. However, it would require the device to be at least as reliable in detecting cancers than current methods (though more false positives would be acceptable) for it to become a reliable first step of diagnosis.

A good example of a field, engineering, bringing its expertise to another field, medicine, to help solve a problem. Hopefully it will fulfill its potential.

A couple of interesting PLoS articles

Translating Pharmacogenomics: Challenges on the Road to the Clinic by Jesse J. Swen et al in PLoS Medicine

Pharmacogenomics is one of the first clinical applications of the postgenomic era. It promises personalized medicine rather than the established “one size fits all” approach to drugs and dosages. The expected reduction in trial and error should ultimately lead to more efficient and safer drug therapy. In recent years, commercially available pharmacogenomic tests have been approved by the Food and Drug Administration (FDA), but their application in patient care remains very limited. More generally, the implementation of pharmacogenomics in routine clinical practice presents significant challenges. This article presents specific clinical examples of such challenges and discusses how obstacles to implementation of pharmacogenomic testing can be addressed.

Explains why the mapping of the human genome has yet to result in the expected tailoring of medicine, that take into account genetic differences.

Protistan Diversity in the Arctic: A Case of Paleoclimate Shaping Modern Biodiversity? by Thorsten Stoeck et al in PLoS One

The impact of climate on biodiversity is indisputable. Climate changes over geological time must have significantly influenced the evolution of biodiversity, ultimately leading to its present pattern. Here we consider the paleoclimate data record, inferring that present-day hot and cold environments should contain, respectively, the largest and the smallest diversity of ancestral lineages of microbial eukaryotes.

The findings are quite interesting

Conclusions/Significance

This pattern is consistent with natural selection sweeps on aerobic non-psychrophilic microbial eukaryotes repeatedly caused by low temperatures and global anoxia of snowball Earth conditions. It implies that cold refuges persisted through the periods of greenhouse conditions, which agrees with some, although not all, current views on the extent of the past global cooling and warming events. We therefore identify cold environments as promising targets for microbial discovery.

In other words, it seems like cold climates have the greates bio-diversity, probably due to the fact that these environments have stayed fairly unchanged through time.

Potential malaria vaccination fail

PLoS One brings the results of a follow-up on a trial of a potential malaria vaccination, and unfortuntately it appears that it doesn't work, at least not for children. If I read the article right, the vaccination provides some protection for adults, which is probably why it was tried on children.

Extended Follow-Up Following a Phase 2b Randomized Trial of the Candidate Malaria Vaccines FP9 ME-TRAP and MVA ME-TRAP among Children in Kenya by Philip Bejon et al.

Background

“FFM ME-TRAP” is sequential immunisation with two attenuated poxvirus vectors (FP9 and modified vaccinia virus Ankara) delivering the pre-erythrocytic malaria antigen ME-TRAP. Over nine months follow-up in our original study, there was no evidence that FFM ME-TRAP provided protection against malaria. The incidence of malaria was slightly higher in children who received FFM ME-TRAP, but this was not statistically significant (hazard ratio 1.5, 95% CI 1.0-2.3). Although the study was unblinded, another nine months follow-up was planned to monitor the incidence of malaria and other serious adverse events.

Methods and Findings

405 children aged 1–6 yrs were initially randomized to vaccination with either FFM ME-TRAP or control (rabies vaccine). 380 children were still available for follow-up after the first nine months. Children were seen weekly and whenever they were unwell for nine months monitoring. The axillary temperature was measured, and blood films taken when febrile. The primary analysis was time to parasitaemia >2,500/µl. During the second nine months monitoring, 49 events met the primary endpoint (febrile malaria with parasites >2,500/µl) in the Intention To Treat (ITT) group. 23 events occurred among the 189 children in the FFM ME-TRAP group, and 26 among the 194 children in the control group. In the full 18 months of monitoring, there were 63 events in the FFM ME-TRAP group and 60 in the control group (HR = 1.2, CI 0.84-1.73, p = 0.35). There was no evidence that the HR changed over the 18 months (test for interaction between time and vaccination p = 0.11).

Conclusions

Vaccination with FFM ME-TRAP was not protective against malaria in this study. Malaria incidence during 18 months of surveillance was similar in both vaccine groups.

The original nine month trial, to which this was a follow-up, didn't show any evidence of any protection against malaria, and this study verifies those findings. A pity, because we could certainly use more vectors against malaria. The results however, makes it possible for scientists and medical professionals to focus on other more promising ideas.